Individual
JESSICA GARDENIA VAJARAKITIPONGSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
2815 S MAIN ST STE 205, CORONA, CA 92882-2533
(951) 475-1307
(951) 475-1308
Mailing address
747 LASSEN DR, CORONA, CA 92879-5980
(951) 751-8612
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
11386
CA
Other
Enumeration date
09/09/2013
Last updated
04/24/2019
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