Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 39975 | CA |
NPI | 1003212291 |
---|---|
Provider Name | Patricia Venegas |
First Address | Pasadena, CA 91103-3618 |
Second Address | Arcadia, CA 91006-3776 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2014 |
Last Update Date | 14/11/2014 |