Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1043579394 |
---|---|
Provider Name | Teresa Margaret Jasso |
First Address | Norwalk, CA 90650-4382 |
Second Address | Norwalk, CA 90650-4382 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/05/2012 |
Last Update Date | 07/05/2012 |