Individual
MS. SUSAN K NAKAYA AVILA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
115 BRIDGE ST, SAN GABRIEL, CA 91775-2719
(626) 289-4439
Mailing address
115 BRIDGE ST, SAN GABRIEL, CA 91775-2719
(626) 289-4439
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
500
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500
—
CA
Enumeration date
12/24/2012
Last updated
01/07/2015
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