Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | OTA704 | CA |
NPI | 1942412192 |
---|---|
Provider Name | Miss Gina Renee Aguilar |
First Address | Lake Forest, CA 92630-7607 |
Second Address | San Juan Capistrano, CA 92675-6722 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2007 |
Last Update Date | 26/04/2010 |