Basic Information
Provider Information
NPI: 1003140823
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: OUSTAD
FirstName: MARIA
MiddleName: CAROLINA
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2008 N GAREY AVE
Address2:  
City: POMONA
State: CA
PostalCode: 917672722
CountryCode: US
TelephoneNumber: 9097843236
FaxNumber: 9098650730
Practice Location
Address1: 2008 N GAREY AVE
Address2:  
City: POMONA
State: CA
PostalCode: 917672722
CountryCode: US
TelephoneNumber: 9097843236
FaxNumber: 9098650730
Other Information
ProviderEnumerationDate: 09/25/2009
LastUpdateDate: 05/10/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225400000X  Y Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner 

No ID Information.


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