Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1023781127 |
---|---|
Provider Name | Samantha Arreola |
First Address | Baldwin Park, CA 91706-3060 |
Second Address | Glendora, CA 91740-5000 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2021 |
Last Update Date | 26/07/2021 |