Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 23353 | CA |
N | 111NI0013X | Independent Medical Examiner | 23353 | CA |
NPI | 1609128529 |
---|---|
Provider Name | Ms. Kerrie Pratt |
First Address | Los Angeles, CA 90009-0570 |
Second Address | Los Angeles, CA 90022-1754 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2012 |
Last Update Date | 03/10/2012 |