Basic Information
| Provider Information | |||||||||
| NPI: | 1992725154 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BERENBEIM | ||||||||
| FirstName: | ROXANE | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | OTR/R, RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 20 OAK CANYON TRL | ||||||||
| Address2: | |||||||||
| City: | COTO DE CAZA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926794915 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9498427562 | ||||||||
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| Practice Location | |||||||||
| Address1: | 631 S BROOKHURST ST | ||||||||
| Address2: | #106 | ||||||||
| City: | ANAHEIM | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928043510 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7144907711 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/20/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | OT7536 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.