Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2251E1300X | Electrophysiology, Clinical | 21 | CA |
N | 2251P0200X | Physical Therapist - Pediatrics | 13000 | CA |
NPI | 1063548543 |
---|---|
Provider Name | Ms. Susan Ann Rethlefsen |
First Address | Los Angeles, CA 90027-6062 |
Second Address | Los Angeles, CA 90027-6062 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/02/2007 |
Last Update Date | 08/07/2007 |