Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 2799 | CA |
NPI | 1598434003 |
---|---|
Provider Name | Jennifer Azares High |
First Address | Beaumont, CA 92223-3136 |
Second Address | Redlands, CA 92373-4845 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/09/2021 |
Last Update Date | 08/09/2021 |