Individual
MRS. ELISA VICTORIA JIANG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
REGISTERED OTR
Contact information
Practice address
17842 IRVINE BLVD STE 118, TUSTIN, CA 92780-3243
(949) 903-8229
Mailing address
17842 IRVINE BLVD STE 118, TUSTIN, CA 92780-3243
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
404862
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
404862
CERTIFICATION NUMBER
—
Enumeration date
11/15/2018
Last updated
11/15/2018
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