Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TR0400X | Rehabilitation Psychologist | OTA3935 | CA |
NPI | 1346885878 |
---|---|
Provider Name | Edna M Osorio Lopez |
First Address | Ontario, CA 91762-6240 |
Second Address | Ontario, CA 91762-6240 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/11/2019 |
Last Update Date | 07/11/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
NA | NA (01) | CA |