Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 226300000X | Kinesiotherapist | 23918 | CA |
NPI | 1528542776 |
---|---|
Provider Name | Nishan A Tesfaye |
First Address | Los Angeles, CA 90016-1608 |
Second Address | Los Angeles, CA 90027-5969 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/09/2018 |
Last Update Date | 23/09/2018 |