Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | OT7350 | CA |
N | 225XF0002X | Feeding, Eating & Swallowing | OT7350 | CA |
N | 225XP0200X | Occupational Therapist - Pediatrics | OT7350 | CA |
NPI | 1659706539 |
---|---|
Provider Name | Mrs. Renee Marie Morones Fabian |
First Address | Encinitas, CA 92024-1761 |
Second Address | Carlsbad, CA 92008-6540 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/09/2013 |
Last Update Date | 10/09/2013 |