Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 234525 | MA |
NPI | 1053529453 |
---|---|
Provider Name | Rose S Bernal-Larioza |
First Address | Chicopee, MA 01020-1969 |
Second Address | Chicopee, MA 01020-1969 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2007 |
Last Update Date | 26/01/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
110080962/A | (05) | MA |