Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 2392 | CA |
NPI | 1700275021 |
---|---|
Provider Name | Hannah Nguyen |
First Address | Lake Elsinore, CA 92532-0413 |
Second Address | Lake Elsinore, CA 92532-0413 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/01/2015 |
Last Update Date | 12/01/2015 |