Individual
JACOB KRISTOFER ALBA WONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3909 W 176TH ST, TORRANCE, CA 90504-3212
(310) 533-7963
Mailing address
3909 W 176TH ST, TORRANCE, CA 90504-3212
(310) 533-7963
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
6381
CA
Other
Enumeration date
04/29/2024
Last updated
04/29/2024
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