Basic Information
| Provider Information | |||||||||
| NPI: | 1992343495 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TOMKINS | ||||||||
| FirstName: | DANA | ||||||||
| MiddleName: | ROSE | ||||||||
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| Credential: | COTA/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 247 E BOBIER DR | ||||||||
| Address2: | |||||||||
| City: | VISTA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920843026 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7609453033 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 247 E BOBIER DR | ||||||||
| Address2: | |||||||||
| City: | VISTA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920843026 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7609453033 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/15/2019 | ||||||||
| LastUpdateDate: | 12/15/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 12/15/2019 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224Z00000X | 3440 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
No ID Information.