Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1043450141 |
---|---|
Provider Name | Ms. Lucia Enriqueta Nishimura |
First Address | Santa Clarita, CA 91350-2947 |
Second Address | Santa Clarita, CA 91350-2947 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/03/2009 |
Last Update Date | 30/05/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1892 | (05) | CA |