Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 23711 | CA |
NPI | 1043415235 |
---|---|
Provider Name | Quennie M. Basa |
First Address | Downey, CA 90242-2812 |
Second Address | Downey, CA 90242-2812 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2007 |
Last Update Date | 03/12/2021 |