Individual
ELVY ADALIE FUENTES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1203 W GARDENA BLVD APT B, GARDENA, CA 90247-5056
(310) 982-3623
Mailing address
1203 W GARDENA BLVD APT B, GARDENA, CA 90247-5056
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
22453
CA
Other
Enumeration date
06/30/2021
Last updated
06/30/2021
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