Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 4168 | CA |
NPI | 1003467929 |
---|---|
Provider Name | Cristian Armenta Ibarra |
First Address | Fontana, CA 92335-5512 |
Second Address | Fontana, CA 92335-5512 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/09/2019 |
Last Update Date | 23/09/2019 |