Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | OT5509 | CA |
NPI | 1003150541 |
---|---|
Provider Name | Dr. Gustavo Alejandro Reinoso |
First Address | Los Angeles, CA 90034-3216 |
Second Address | Los Angeles, CA 90034-3216 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/11/2012 |
Last Update Date | 07/12/2012 |