Healthcare Provider Details

I. General information

NPI: 1487406906
Provider Name (Legal Business Name): LESLIE DIANE HUITRON OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2024
Last Update Date: 09/19/2024
Certification Date: 09/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 S MARY AVE STE 1
NIPOMO CA
93444-7821
US

IV. Provider business mailing address

1111 S BROADWAY STE 201
SANTA MARIA CA
93454-6682
US

V. Phone/Fax

Practice location:
  • Phone: 805-929-3230
  • Fax: 805-929-3232
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number26190
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number26190
License Number StateCA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: