Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 5358 | CA |
NPI | 1013520725 |
---|---|
Provider Name | Talia M Bentivengo |
First Address | Temecula, CA 92590-2858 |
Second Address | Temecula, CA 92590-2858 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/08/2020 |
Last Update Date | 20/09/2021 |