Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 413011 | CA |
NPI | 1003371295 |
---|---|
Provider Name | Brian My Ha |
First Address | Santa Ana, CA 92703-4221 |
Second Address | Costa Mesa, CA 92626-4865 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/02/2019 |
Last Update Date | 01/02/2019 |