Provider Demographics
NPI:1124597562
Name:RESURRECCION, JOHN
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:RESURRECCION
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15331 JASMINE LN UNIT 106
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90249-4692
Mailing Address - Country:US
Mailing Address - Phone:562-857-4671
Mailing Address - Fax:
Practice Address - Street 1:15331 JASMINE LN UNIT 106
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90249-4692
Practice Address - Country:US
Practice Address - Phone:562-857-4671
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-14
Last Update Date:2021-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19693225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist