Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 7574 | CA |
NPI | 1568136711 |
---|---|
Provider Name | Amabelle Villondo |
First Address | Buena Park, CA 90620-4414 |
Second Address | Buena Park, CA 90620-4414 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/08/2021 |
Last Update Date | 02/08/2021 |