Individual
LILIBETH MORAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
2061 WRIGHT AVE, LA VERNE, CA 91750-5837
(909) 519-8912
Mailing address
5508 N DUXFORD AVE, AZUSA, CA 91702-5625
(626) 723-6617
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
4476
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
JQU415W04477
ANTHEM
CA
Enumeration date
01/19/2022
Last updated
01/19/2022
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