Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 014465 | NY |
NPI | 1053564088 |
---|---|
Provider Name | Ms. Maria Joanna Romualdez Luciano |
First Address | Sunnyside, NY 11104-3829 |
Second Address | New York, NY 10065-8206 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/11/2008 |
Last Update Date | 04/11/2008 |