Basic Information
| Provider Information | |||||||||
| NPI: | 1689877888 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DALISAY | ||||||||
| FirstName: | ROMEO | ||||||||
| MiddleName: | YAMBOT | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | OTR | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10800 MAGNOLIA AVE | ||||||||
| Address2: | |||||||||
| City: | RIVERSIDE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925053043 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9513534670 | ||||||||
| FaxNumber: | 9513534980 | ||||||||
| Practice Location | |||||||||
| Address1: | 10800 MAGNOLIA AVE | ||||||||
| Address2: | |||||||||
| City: | RIVERSIDE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925053043 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9513534670 | ||||||||
| FaxNumber: | 9513534980 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/06/2007 | ||||||||
| LastUpdateDate: | 07/16/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 0237 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.