Individual
EDWARD HALOMOAN SIAHAAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CTRS
Contact information
Practice address
3933 HARRISON ST, RIVERSIDE, CA 92503-3523
(833) 391-0505
Mailing address
3933 HARRISON ST, RIVERSIDE, CA 92503-3523
(833) 391-0505
Taxonomy
Speciality
Code
Description
License number
State
225800000X
Recreation Therapist
Primary
CTRS32156
CA
Other
Enumeration date
04/20/2026
Last updated
04/20/2026
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