Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1013400381 |
---|---|
Provider Name | Rebecca Villanueba Ortiz |
First Address | Martinez, CA 94553-2409 |
Second Address | Napa, CA 94558 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2018 |
Last Update Date | 15/06/2018 |