Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225XG0600X | Occupational Therapist - Gerontology | OT 66 | CA |
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | OT 66 | CA |
NPI | 1770886665 |
---|---|
Provider Name | Mrs. Trina Moreno Yogore |
First Address | Granada Hills, CA 91344-3767 |
Second Address | Northridge, CA 91325-1445 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/12/2010 |
Last Update Date | 14/12/2010 |