Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | OT16540 | CA |
NPI | 1225582034 |
---|---|
Provider Name | Mr. Alexander Bruce Macgregor I |
First Address | Loma Linda, CA 92354-2778 |
Second Address | Loma Linda, CA 92354-2778 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2016 |
Last Update Date | 09/08/2016 |