Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 5663 | CA |
NPI | 1013682772 |
---|---|
Provider Name | Michelle Alfonso |
First Address | Los Angeles, CA 90005-4407 |
Second Address | Placentia, CA 92870-3301 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/08/2021 |
Last Update Date | 13/08/2021 |