Healthcare Provider Details

I. General information

NPI: 1124586441
Provider Name (Legal Business Name): CELINE SABA REZVANI OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2019
Last Update Date: 08/22/2023
Certification Date: 08/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 S FREMONT AVE UNIT 27
ALHAMBRA CA
91803-8849
US

IV. Provider business mailing address

2201 WOOLSEY ST
BERKELEY CA
94705-1832
US

V. Phone/Fax

Practice location:
  • Phone: 626-289-7472
  • Fax:
Mailing address:
  • Phone: 317-989-9980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: