Healthcare Provider Details

I. General information

NPI: 1174911309
Provider Name (Legal Business Name): ISAC JEYAPAUL OTR/L
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/22/2014
Last Update Date: 12/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13104 GLEN CT UNIT 70
CHINO HILLS CA
91709-1126
US

IV. Provider business mailing address

13104 GLEN CT UNIT 70
CHINO HILLS CA
91709-1126
US

V. Phone/Fax

Practice location:
  • Phone: 909-933-3780
  • Fax: 909-933-3780
Mailing address:
  • Phone: 909-933-3780
  • Fax: 909-933-3780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT 949
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: