Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 612 | CA |
NPI | 1033267646 |
---|---|
Provider Name | Augustus Caesar Fatardo Sese |
First Address | Pleasant Hill, CA 94523 |
Second Address | Pleasant Hill, CA 94523 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/01/2007 |
Last Update Date | 22/12/2014 |