Healthcare Provider Details

I. General information

NPI: 1235894080
Provider Name (Legal Business Name): MARIANNE MENESES OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2021
Last Update Date: 04/17/2026
Certification Date: 04/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17800 CALIFORNIA 18
APPLE VALLEY CA
92307
US

IV. Provider business mailing address

4578 JESSICA DR
LOS ANGELES CA
90065-4116
US

V. Phone/Fax

Practice location:
  • Phone: 760-646-8000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number19897
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: