Healthcare Provider Details

I. General information

NPI: 1508490483
Provider Name (Legal Business Name): BRENDAN LASCALA OTR/L
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2020
Last Update Date: 03/30/2022
Certification Date: 03/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11840 S LA CIENEGA BLVD
HAWTHORNE CA
90250-3459
US

IV. Provider business mailing address

1540 ALCAZAR ST STE 133
LOS ANGELES CA
90089-1029
US

V. Phone/Fax

Practice location:
  • Phone: 424-269-3400
  • Fax: 310-882-5451
Mailing address:
  • Phone: 323-442-3550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: