Individual
NESTLE ILANO QUIAMBAO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
5310 FOUNTAIN AVE, LOS ANGELES, CA 90029-1005
(323) 461-9961
Mailing address
121 W MAPLE ST APT 1, GLENDALE, CA 91204-2137
(818) 237-6300
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
6596
CA
Other
Enumeration date
11/13/2023
Last updated
11/13/2023
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