Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 19540 | CA |
NPI | 1003576455 |
---|---|
Provider Name | Zack Elias Pinto |
First Address | Culver City, CA 90232-3213 |
Second Address | Santa Monica, CA 90404-4605 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/12/2021 |
Last Update Date | 27/12/2021 |