Healthcare Provider Details

I. General information

NPI: 1336719608
Provider Name (Legal Business Name): RIANNA WONG MACHIDA OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2021
Last Update Date: 06/29/2021
Certification Date: 06/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11605 WASHINGTON PL
LOS ANGELES CA
90066-5013
US

IV. Provider business mailing address

2825 TILDEN AVE
LOS ANGELES CA
90064-4011
US

V. Phone/Fax

Practice location:
  • Phone: 310-337-7115
  • Fax:
Mailing address:
  • Phone: 310-280-8639
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number22464
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: