Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | OT 8854 | CA |
NPI | 1003299736 |
---|---|
Provider Name | Mr. Jacob Baquir |
First Address | Carson, CA 90745-4637 |
Second Address | Carson, CA 90745-4637 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2015 |
Last Update Date | 30/06/2015 |