Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 33914 | CA |
NPI | 1003088063 |
---|---|
Provider Name | Nicole M Irizarry |
First Address | San Diego, CA 92104 |
Second Address | Chula Vista, CA 91911-2519 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/03/2008 |
Last Update Date | 31/03/2008 |