Individual
NICOLE MARIE PETRUSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
8030 LA MESA BLVD # 416, LA MESA, CA 91942-0335
(619) 567-9448
Mailing address
8826 JACKIE DR, SAN DIEGO, CA 92119-1418
(619) 992-8364
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
26623
CA
Other
Enumeration date
06/03/2018
Last updated
11/15/2024
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