Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology |
NPI | 1245990357 |
---|---|
Provider Name | Elia Attar |
First Address | Tarzana, CA 91356-3656 |
Second Address | Tarzana, CA 91356-3656 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/12/2021 |
Last Update Date | 30/12/2021 |