Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1053646208 |
---|---|
Provider Name | Vanessa Barrera |
First Address | Pasadena, CA 91107-3464 |
Second Address | Pasadena, CA 91107-3464 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2009 |
Last Update Date | 01/10/2013 |