Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | OTA5370 | CA |
NPI | 1003407479 |
---|---|
Provider Name | Josue Sandoval |
First Address | Sacramento, CA 95829-1568 |
Second Address | Pleasant Hill, CA 94523-4487 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/01/2021 |
Last Update Date | 28/01/2021 |