Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 12463 | CA |
N | 225XG0600X | Occupational Therapist - Gerontology | 46TR00515700 | NJ |
NPI | 1306163746 |
---|---|
Provider Name | Dennis Alphonsus G Chua |
First Address | Beaumont, CA 92223-3258 |
Second Address | Beaumont, CA 92223-3258 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2010 |
Last Update Date | 03/02/2022 |