Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | OT 2751 | CA |
NPI | 1003107046 |
---|---|
Provider Name | Ria Resurreccion Camerino |
First Address | Irvine, CA 92603-0608 |
Second Address | Tampa, FL 33607-5917 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2011 |
Last Update Date | 26/04/2011 |