Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | ||
N | 225XM0800X | Mental Health |
NPI | 1043739469 |
---|---|
Provider Name | Sharon Vincuilla |
First Address | Studio City, CA 91604-5032 |
Second Address | Studio City, CA 91604-5032 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/09/2017 |
Last Update Date | 18/09/2017 |