Healthcare Provider Details

I. General information

NPI: 1306163746
Provider Name (Legal Business Name): DENNIS ALPHONSUS G CHUA OTR/L
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: DENNIS ALPHONSUS G REYES CHUA OTD, OTR/L, CAPS

II. Dates (important events)

Enumeration Date: 04/26/2010
Last Update Date: 02/03/2022
Certification Date: 02/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1326 MELSTONE ST
BEAUMONT CA
92223-3258
US

IV. Provider business mailing address

1326 MELSTONE ST
BEAUMONT CA
92223-3258
US

V. Phone/Fax

Practice location:
  • Phone: 909-901-3100
  • Fax:
Mailing address:
  • Phone: 909-901-3100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XG0600X
TaxonomyGerontology Occupational Therapist
License Number46TR00515700
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code225XG0600X
TaxonomyGerontology Occupational Therapist
License Number12463
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: