Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | OT 557 | CA |
Y | 225XM0800X | Mental Health | OT557 | CA |
NPI | 1831215425 |
---|---|
Provider Name | Ruth Sun |
First Address | Pomona, CA 91767-2722 |
Second Address | Pomona, CA 91767-2722 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2007 |
Last Update Date | 29/09/2020 |