Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 351611 | TX |
NPI | 1003321225 |
---|---|
Provider Name | Mr. David Nava JR. |
First Address | El Paso, TX 79936-8031 |
Second Address | El Paso, TX 79936-8031 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/12/2017 |
Last Update Date | 11/12/2017 |