Individual
MR. JAIME AGUSTIN SIU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
448 MYRTLE ST APT 4, GLENDALE, CA 91203-2196
(818) 913-2962
Mailing address
448 MYRTLE ST APT 4, GLENDALE, CA 91203-2196
(818) 913-2962
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTA2859
CA
Other
Enumeration date
03/25/2019
Last updated
03/25/2019
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