Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 10975 | CA |
NPI | 1811232739 |
---|---|
Provider Name | Annie Park |
First Address | Irvine, CA 92614-5851 |
Second Address | Irvine, CA 92614-5851 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/12/2012 |
Last Update Date | 04/12/2012 |