Healthcare Provider Details

I. General information

NPI: 1437782224
Provider Name (Legal Business Name): LISAANN OKUBO OT/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2020
Last Update Date: 02/20/2020
Certification Date: 02/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14901 RINALDI ST
MISSION HILLS CA
91345-1204
US

IV. Provider business mailing address

22146 ALTAIR LN
SANTA CLARITA CA
91390-5754
US

V. Phone/Fax

Practice location:
  • Phone: 818-365-9690
  • Fax:
Mailing address:
  • Phone: 661-542-3191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: