Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251S0007X | Physical Therapist - Sports | PT41735 | CA |
NPI | 1396131173 |
---|---|
Provider Name | Sophia Gonzalez |
First Address | Los Angeles, CA 90031-0309 |
Second Address | Los Angeles, CA 90089-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/04/2015 |
Last Update Date | 10/09/2021 |