Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | 32597 | CA |
NPI | 1013190032 |
---|---|
Provider Name | Ms. Jennifer S Tanaka |
First Address | La Palma, CA 90623-2026 |
Second Address | La Palma, CA 90623-2026 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/12/2007 |
Last Update Date | 12/12/2007 |