Healthcare Provider Details

I. General information

NPI: 1568387769
Provider Name (Legal Business Name): STEPHANIE FORTUNATO OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1625 E MAIN ST STE 101&104
EL CAJON CA
92021-5211
US

IV. Provider business mailing address

1625 E MAIN ST STE 101&104
EL CAJON CA
92021-5211
US

V. Phone/Fax

Practice location:
  • Phone: 619-873-2160
  • Fax:
Mailing address:
  • Phone: 619-873-2160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number29463
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: