Healthcare Provider Details

I. General information

NPI: 1497959498
Provider Name (Legal Business Name): RAISSA SYBYLL PISON BORRO OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RAISSA SYBYLL DAQUILANEA PISON OTR/L

II. Dates (important events)

Enumeration Date: 06/13/2007
Last Update Date: 12/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 N HARBOR BLVD
FULLERTON CA
92835-1727
US

IV. Provider business mailing address

27442 PORTOLA PKWY STE 200
FOOTHILL RANCH CA
92610-2822
US

V. Phone/Fax

Practice location:
  • Phone: 714-871-9202
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT 12976
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: