Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 21557 | CA |
N | 225XH1200X | Occupational Therapist - Hand | 21557 | CA |
NPI | 1003420316 |
---|---|
Provider Name | Ricky Chavez |
First Address | Norwalk, CA 90650 |
Second Address | Norwalk, CA 90650 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/09/2020 |
Last Update Date | 03/09/2020 |