Individual
JACKSON CABRERA LAUS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
COTA/L
Contact information
Practice address
2800 RIVERSIDE DR APT 203, LOS ANGELES, CA 90039-2166
(323) 434-1414
Mailing address
2800 RIVERSIDE DR APT 203, LOS ANGELES, CA 90039-2166
(323) 434-1414
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
4628
CA
Other
Enumeration date
12/30/2019
Last updated
12/30/2019
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