Individual
MARTIN LAGO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
5310 FOUNTAIN AVE, LOS ANGELES, CA 90029-1005
(323) 461-9961
Mailing address
405 N MADISON AVE, UNIT 9, PASADENA, CA 91101-1439
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
3001
CA
Other
Enumeration date
01/18/2015
Last updated
01/18/2015
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