Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 1756 | CA |
NPI | 1003082637 |
---|---|
Provider Name | Ms. Lynn Annette Herzberg |
First Address | Trabuco Canyon, CA 92679-1610 |
Second Address | Laguna Hills, CA 92653-1447 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2008 |
Last Update Date | 04/05/2008 |