Basic Information
| Provider Information | |||||||||
| NPI: | 1356508774 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RESPICIO | ||||||||
| FirstName: | MARIA | ||||||||
| MiddleName: | |||||||||
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| Credential: | OTR/L | ||||||||
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| OtherLastName: | AZA | ||||||||
| OtherFirstName: | MARIA | ||||||||
| OtherMiddleName: | FELICIANO | ||||||||
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| OtherCredential: | OTR/L | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1122 E ELK AVE | ||||||||
| Address2: | # 105 | ||||||||
| City: | GLENDALE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 912054603 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8183995545 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3002 ROWENA AVE | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900392005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3236661544 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/22/2008 | ||||||||
| LastUpdateDate: | 05/22/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 3432 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.