Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1053823286 |
---|---|
Provider Name | Ruby Huerta |
First Address | Los Angeles, CA 90007-3033 |
Second Address | Los Angeles, CA 90007-4203 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/10/2017 |
Last Update Date | 27/10/2017 |