Healthcare Provider Details

I. General information

NPI: 1124795919
Provider Name (Legal Business Name): ABIGAIL FABUNAN CARRASCO OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2021
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30131 TOWN CENTER DR STE 135
LAGUNA NIGUEL CA
92677-2010
US

IV. Provider business mailing address

153 KINGS CYN
IRVINE CA
92606-1913
US

V. Phone/Fax

Practice location:
  • Phone: 949-594-4455
  • Fax:
Mailing address:
  • Phone: 951-219-8922
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number28795
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: