Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | DC15784 | CA |
NPI | 1104035773 |
---|---|
Provider Name | Sheila Marie Beardo |
First Address | Los Angeles, CA 90039-1805 |
Second Address | Los Angeles, CA 90039-1805 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2007 |
Last Update Date | 08/07/2007 |