Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225XN1300X | Occupational Therapist - Neurorehabilitation | ||
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation |
NPI | 1356985311 |
---|---|
Provider Name | Ms. Ran Chu |
First Address | Gardena, CA 90248-4022 |
Second Address | Los Angeles, CA 90015-3010 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/11/2019 |
Last Update Date | 03/11/2019 |