Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 11463 | CA |
NPI | 1053685271 |
---|---|
Provider Name | Erica Nicole Atles Yslas |
First Address | Rancho Santa Margarita, CA 92688-5532 |
Second Address | Santa Ana, CA 92707-3656 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/03/2012 |
Last Update Date | 06/03/2012 |