Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 8386 | CA |
NPI | 1003896135 |
---|---|
Provider Name | Tiffanie Melumar Pon |
First Address | San Francisco, CA 94122-3218 |
Second Address | Glendale, CA 91203-2194 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/01/2006 |
Last Update Date | 08/07/2007 |