Modesto Andrew Formilleza
ActiveCalifornia license 12701
License
- Licensed by
- California Board of Occupational Therapy
- License number
- 12701
- Status
- Active (Current)
- First issued
- June 14, 2012
- Expires
- November 30, 2026
- License holder
- Modesto Andrew Formilleza
- Entity type
- Individual
Classifications
- Occupational Therapist Therapy & Rehabilitation
More from the license record
- License type code
- 7101
Contact
12102 Chili Pepper Lane
Garden Grove, CA 92840
Garden Grove, CA 92840
Orange County