Healthcare Provider Details

I. General information

NPI: 1710136957
Provider Name (Legal Business Name): NEILLE MIKA YAMAGUCHI O.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2008
Last Update Date: 09/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 E LAMBERT RD SUITE 220
BREA CA
92821-4370
US

IV. Provider business mailing address

1800 E LAMBERT RD SUITE 220
BREA CA
92821-4370
US

V. Phone/Fax

Practice location:
  • Phone: 714-256-5074
  • Fax: 714-256-0770
Mailing address:
  • Phone: 714-256-5074
  • Fax: 714-256-0770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT 7455
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: