Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1013288265 |
---|---|
Provider Name | Ms. Janet Rico |
First Address | Pacoima, CA 91331-1338 |
Second Address | Pacoima, CA 91331-1338 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/01/2012 |
Last Update Date | 19/01/2012 |