Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 7738 | CA |
NPI | 1063858876 |
---|---|
Provider Name | Erica Villalvazo Hernandez |
First Address | Fullerton, CA 92832-3038 |
Second Address | Fullerton, CA 92832-3038 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/05/2013 |
Last Update Date | 20/05/2013 |