Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | 18881 | CA |
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | 18881 | CA |
NPI | 1699369462 |
---|---|
Provider Name | Arturo Itchon Abrera JR. |
First Address | Stockton, CA 95209-1807 |
Second Address | Stockton, CA 95209-1807 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/02/2021 |
Last Update Date | 23/02/2021 |