Individual
MIRIAN DE MOURA SOUZA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
11371 RIVERPASS CT, RIVERSIDE, CA 92505-5162
(949) 302-3948
Mailing address
11371 RIVERPASS CT, RIVERSIDE, CA 92505-5162
(949) 302-3948
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
2865
CA
Other
Enumeration date
12/31/2014
Last updated
12/31/2014
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