Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner | CA |
NPI | 1033298260 |
---|---|
Provider Name | Ms. Edith Gutierrez |
First Address | Los Angeles, CA 90020 |
Second Address | Los Angeles, CA 90020 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/11/2006 |
Last Update Date | 17/06/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
495502 | EMPLOYEE ID (01) | CA |