Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | OT2947 | CA |
NPI | 1063532463 |
---|---|
Provider Name | Ms. Rachelle Gavino |
First Address | El Cajon, CA 92019-1046 |
Second Address | El Cajon, CA 92019-0000 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2007 |
Last Update Date | 05/03/2010 |