Healthcare Provider Details

I. General information

NPI: 1770040891
Provider Name (Legal Business Name): STEPHANIE LINARES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2019
Last Update Date: 03/19/2024
Certification Date: 03/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2736 W SAVOY PL
ANAHEIM CA
92804-2017
US

IV. Provider business mailing address

2736 W SAVOY PL
ANAHEIM CA
92804-2017
US

V. Phone/Fax

Practice location:
  • Phone: 562-290-9798
  • Fax:
Mailing address:
  • Phone: 562-290-9798
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number25532
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: