Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | 5004 | CA |
NPI | 1285039230 |
---|---|
Provider Name | Prof. Jess Anthony Holguin |
First Address | Los Angeles, CA 90033-5313 |
Second Address | Los Angeles, CA 90033-5313 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2014 |
Last Update Date | 01/11/2014 |