Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1023772571 |
---|---|
Provider Name | Sheyanne Jackson Booth |
First Address | Huntington Park, CA 90255-3699 |
Second Address | Huntington Park, CA 90255-3699 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/10/2021 |
Last Update Date | 29/10/2021 |