Individual
DUSTIN THOMAS GONZAGA-BEAVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OTR/L
Contact information
Practice address
2601 AIRPORT DR STE 115, TORRANCE, CA 90505-6133
(310) 325-7404
Mailing address
5655 E CALLE CANADA, ANAHEIM, CA 92807-3720
(657) 282-2000
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
24722
CA
Other
Enumeration date
03/17/2023
Last updated
02/23/2024
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