Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 20020 | CA |
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation |
NPI | 1063066918 |
---|---|
Provider Name | Erica Maria Pueblos |
First Address | Lakewood, CA 90712-1465 |
Second Address | Lakewood, CA 90712-1465 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/07/2019 |
Last Update Date | 30/07/2019 |