Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 3353 | CA |
NPI | 1003452863 |
---|---|
Provider Name | Gelbert G De Guzman |
First Address | Encino, CA 91436-2203 |
Second Address | Encino, CA 91436-2203 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/11/2019 |
Last Update Date | 14/04/2020 |