Healthcare Provider Details

I. General information

NPI: 1366057903
Provider Name (Legal Business Name): REICZEL HALA BACHO BAEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2020
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 ORANGEFAIR MALL
FULLERTON CA
92832-3038
US

IV. Provider business mailing address

233 ORANGEFAIR MALL
FULLERTON CA
92832-3038
US

V. Phone/Fax

Practice location:
  • Phone: 714-870-6116
  • Fax:
Mailing address:
  • Phone: 714-870-6116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number5291
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: