Individual
SEAN VICTORIA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3541 PUENTE AVE, BALDWIN PARK, CA 91706-5534
(626) 962-1043
Mailing address
2981 CROOKED CREEK DR, DIAMOND BAR, CA 91765-3408
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
260569
CA
224Z00000X
Occupational Therapy Assistant
Primary
3427
CA
Other
Enumeration date
12/23/2015
Last updated
12/23/2015
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