=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437626561
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MR. MICHAEL TUAZON JARVINA
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/26/2018
-----------------------------------------------------
Last Update Date | 04/29/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11618 SOUTH ST UNIT 201
-----------------------------------------------------
City | ARTESIA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90701-6618
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-467-0777
-----------------------------------------------------
Fax | 562-683-3047
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11618 SOUTH ST UNIT 201
-----------------------------------------------------
City | ARTESIA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90701-6618
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-467-0777
-----------------------------------------------------
Fax | 562-683-3047
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 224Z00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapy Assistant
-----------------------------------------------------
License Number | 4614
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------