Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1003140823 |
---|---|
Provider Name | Maria Carolina Oustad |
First Address | Pomona, CA 91767-2722 |
Second Address | Pomona, CA 91767-2722 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/09/2009 |
Last Update Date | 10/05/2013 |