Individual
KATHLEEN LARA ACOSTA ERESE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5905 SEVERIN DR, LA MESA, CA 91942-3806
(619) 589-2606
Mailing address
5905 SEVERIN DR, LA MESA, CA 91942-3806
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
21391
CA
Other
Enumeration date
04/13/2021
Last updated
04/13/2021
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