Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | 23010 | CA |
NPI | 1093472201 |
---|---|
Provider Name | Sepanta Yousefian |
First Address | Irvine, CA 92618-3194 |
Second Address | Anaheim, CA 92801-5614 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/11/2021 |
Last Update Date | 22/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
S81813414 | DRIVER'S LICENSE (01) | MA |