Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225XG0600X | Occupational Therapist - Gerontology | OT 10247 | CA |
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | OT 10247 | CA |
NPI | 1265707764 |
---|---|
Provider Name | Maria Donna Baltazar |
First Address | Anaheim, CA 92801-6760 |
Second Address | Anaheim, CA 92804-1810 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/03/2012 |
Last Update Date | 16/03/2012 |