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Individual

JARIQUO BAKING LUMARQUE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
COTA/L

Contact information

Practice address
9764 GARDEN GROVE BLVD, GARDEN GROVE, CA 92844-1615
(714) 534-0007
(714) 534-0004
Mailing address
14815 DOMART AVE, NORWALK, CA 90650-5303
(562) 881-6486

Taxonomy

Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTA4993
CA

Other

Enumeration date
01/10/2020
Last updated
03/02/2020
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