Healthcare Provider Details

I. General information

NPI: 1356539506
Provider Name (Legal Business Name): PRISCILLA HUANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2007
Last Update Date: 10/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23271 VERDUGO DR STE B
LAGUNA HILLS CA
92653-1347
US

IV. Provider business mailing address

28 SEQUOIA DR
ALISO VIEJO CA
92656-4218
US

V. Phone/Fax

Practice location:
  • Phone: 949-707-5555
  • Fax:
Mailing address:
  • Phone: 949-305-0769
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5702
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: