Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | 19806 | CA |
Y | 225XM0800X | Mental Health |
NPI | 1922555028 |
---|---|
Provider Name | Kimberly Jones |
First Address | Torrance, CA 90502-1029 |
Second Address | Torrance, CA 90502-1029 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/09/2016 |
Last Update Date | 23/01/2020 |