Provider Demographics
NPI:1184264772
Name:LUMARQUE, JARIQUO BAKING (COTA/L)
Entity type:Individual
Prefix:
First Name:JARIQUO
Middle Name:BAKING
Last Name:LUMARQUE
Suffix:
Gender:M
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14815 DOMART AVE
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CA
Mailing Address - Zip Code:90650-5303
Mailing Address - Country:US
Mailing Address - Phone:562-881-6486
Mailing Address - Fax:
Practice Address - Street 1:9764 GARDEN GROVE BLVD
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92844-1615
Practice Address - Country:US
Practice Address - Phone:714-534-0007
Practice Address - Fax:714-534-0004
Is Sole Proprietor?:No
Enumeration Date:2020-01-10
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOTA4993224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant