Individual
JENNELYN LIANG VILLANUEVA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
14335 IBEX AVE, NORWALK, CA 90650-4961
(310) 801-2538
Mailing address
14335 IBEX AVE, NORWALK, CA 90650-4961
(310) 801-2538
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
21856
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
85-3327339
IRS
CA
Enumeration date
01/05/2021
Last updated
01/05/2021
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