Individual
TIE SU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
826 SILVER FIR RD, WALNUT, CA 91789-3220
(909) 979-0892
Mailing address
826 SILVER FIR RD, WALNUT, CA 91789-3220
(909) 979-0892
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
—
Other
Enumeration date
07/03/2024
Last updated
07/03/2024
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