Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1003315409 |
---|---|
Provider Name | Rosa Carmina Juarez |
First Address | Sherman Oaks, CA 91423-3930 |
Second Address | Los Angeles, CA 90010-2632 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/02/2018 |
Last Update Date | 03/02/2020 |