Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 226300000X | Kinesiotherapist | 1616 | CA |
NPI | 1609970276 |
---|---|
Provider Name | Ulysses Salonga Baje JR. |
First Address | Upland, CA 91786-5064 |
Second Address | Sepulveda, CA 91343-2036 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/09/2006 |
Last Update Date | 08/07/2007 |