Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251S0007X | Physical Therapist - Sports | 300660 | CA |
NPI | 1134897507 |
---|---|
Provider Name | Rachel Quan |
First Address | Encino, CA 91436-3647 |
Second Address | Tarzana, CA 91356-3541 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/09/2021 |
Last Update Date | 01/09/2021 |