Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 294419 | CA |
NPI | 1003316969 |
---|---|
Provider Name | Olivia Laura Cruz |
First Address | La Habra, CA 90631-3341 |
Second Address | Diamond Bar, CA 91765-4002 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/02/2018 |
Last Update Date | 25/01/2019 |