Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant |
NPI | 1013563782 |
---|---|
Provider Name | Ms. Josselyn Contreras |
First Address | Corona, CA 92883-6333 |
Second Address | Corona, CA 92883-6333 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2019 |
Last Update Date | 17/08/2019 |