Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | 32144 | CA |
NPI | 1245531367 |
---|---|
Provider Name | Summer San Lucas |
First Address | Loma Linda, CA 92354-3711 |
Second Address | Loma Linda, CA 92354-3711 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/11/2010 |
Last Update Date | 04/11/2010 |