Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | PT10165 | CA |
NPI | 1205209780 |
---|---|
Provider Name | Rajul Vasa |
First Address | Cerritos, CA 90703-2765 |
Second Address | Cerritos, CA 90703-2765 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/11/2015 |
Last Update Date | 05/11/2015 |