Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | PT26458 | CA |
NPI | 1083653802 |
---|---|
Provider Name | Ms. Lisa Dian Paradiso |
First Address | San Rafael, CA 94903-2638 |
Second Address | Novato, CA 94945-5038 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2006 |
Last Update Date | 08/07/2007 |