Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1043745110 |
---|---|
Provider Name | Susy Iracema Perez |
First Address | Fullerton, CA 92836-0919 |
Second Address | Fullerton, CA 92831-3846 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2017 |
Last Update Date | 28/09/2017 |