Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1003199001 |
---|---|
Provider Name | Victor Jones |
First Address | Los Angeles, CA 90017-2114 |
Second Address | Commerce, CA 90040-2449 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2011 |
Last Update Date | 26/09/2011 |