Individual
JOAN RAE M HERMOSURA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
1526 N EDGEMONT ST, LOS ANGELES, CA 90027-5260
(800) 954-8000
Mailing address
22858 BAYWOOD DR, CARSON, CA 90745-4754
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
PT 41096
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PT 41096
PT LICENSE
—
Enumeration date
05/01/2014
Last updated
10/27/2023
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