Individual
MR. DEREK LANE HOUSEHOLDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OTRL
Contact information
Practice address
4650 PALM AVE, SAN DIEGO, CA 92154-8404
(619) 662-6935
Mailing address
4355 VALLE DR, LA MESA, CA 91941-7848
(619) 460-6906
Taxonomy
Speciality
Code
Description
License number
State
225XH1200X
Hand Occupational Therapist
Primary
1031031
CA
Other
Enumeration date
06/25/2007
Last updated
07/08/2007
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