Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | DC18664 | CA |
NPI | 1215968953 |
---|---|
Provider Name | Theresa M Tarcha |
First Address | Redondo Beach, CA 90277-1338 |
Second Address | Manhattan Beach, CA 90266-3278 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2006 |
Last Update Date | 16/12/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T18712 | (02) | CA |