Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | OT9205 | CA |
N | 225XH1200X | Occupational Therapist - Hand | OT9205 | CA |
N | 225XP0200X | Occupational Therapist - Pediatrics | OT9205 | CA |
NPI | 1164557773 |
---|---|
Provider Name | Rosabelle Loan Nguyen |
First Address | Orange, CA 92868-4218 |
Second Address | Orange, CA 92868-4218 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2007 |
Last Update Date | 16/10/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
OT0092050 | BLUE SHIELD PIN (01) | CA |
Q44795 | (02) | CA |