Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 5317 | CA |
NPI | 1396419818 |
---|---|
Provider Name | Mr. Jeremy Luena |
First Address | Trinidad, CA 95570-9727 |
Second Address | Santa Rosa, CA 95405-9407 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/08/2021 |
Last Update Date | 07/08/2021 |