MS. Ida Phae Mack, BA
NPI #1184854788 in North Hills, California
Provider Information
- NPI Number
- 1184854788
- Entity Type
- Individual
- Name
- MS. Ida Phae Mack, BA
- Gender
- Not Specified
- Sole Proprietor
- Yes
- Primary Specialty
- Rehabilitation Practitioner
- Credential
- BA
- Enumeration Date
- Jul 17, 2009
- Last Updated
- Jul 29, 2009
Practice Location
- Address
- 15317 RAYEN ST
- City
- North Hills
- State
- California
- ZIP Code
- 91343-5117
- Phone
- (818) 892-3423
Specialties & Taxonomy Codes
| Specialty |
|---|
| Rehabilitation Practitioner |
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