Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner | CA |
NPI | 1053916502 |
---|---|
Provider Name | Ms. Waynetta Daniel |
First Address | Los Angeles, CA 90003-1311 |
Second Address | Los Angeles, CA 90003-1311 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/12/2020 |
Last Update Date | 12/01/2022 |