Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | 13373 | CA |
Y | 225XG0600X | Occupational Therapist - Gerontology | 13373 | CA |
NPI | 1952866444 |
---|---|
Provider Name | Mrs. Steffi Ellein Rivera De Leon |
First Address | Tulare, CA 93274-7509 |
Second Address | Orange, CA 92867-6462 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/02/2019 |
Last Update Date | 05/03/2019 |