Individual
JULIAN PONFERRADA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2602 NELSON AVE, REDONDO BEACH, CA 90278-2613
(310) 658-3171
Mailing address
120 36TH ST, MANHATTAN BEACH, CA 90266-3202
(310) 658-3171
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
5564
CA
Other
Enumeration date
03/27/2019
Last updated
03/27/2019
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