Individual
ALEXIS MARIE CODILLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6752 LEANNE ST, MIRA LOMA, CA 91752-3476
(951) 427-3889
Mailing address
6752 LEANNE ST, MIRA LOMA, CA 91752-3476
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
3681
CA
Other
Enumeration date
10/08/2016
Last updated
10/08/2016
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