Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | 16438 | CA |
NPI | 1255782074 |
---|---|
Provider Name | Ashok Sadasivaiah |
First Address | Redondo Beach, CA 90277-7206 |
Second Address | Santa Monica, CA 90403-5683 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2016 |
Last Update Date | 07/07/2016 |