Healthcare Provider Details

I. General information

NPI: 1437548203
Provider Name (Legal Business Name): MICHELLE RAMIREZ PENA MSW, MS, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2015
Last Update Date: 04/06/2026
Certification Date: 04/06/2026
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: 562-270-4410
  • 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 Number14737
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: