Individual
DERJEN LUO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
17 SAN RAPHAEL PL, POMONA, CA 91766-4788
(909) 837-5352
Mailing address
17 SAN RAPHAEL PL, POMONA, CA 91766-4788
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
2507
CA
Other
Enumeration date
01/28/2016
Last updated
01/28/2016
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