Healthcare Provider Details

I. General information

NPI: 1376312256
Provider Name (Legal Business Name): ANGELICA D'AGOSTINO OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2023
Last Update Date: 12/20/2023
Certification Date: 12/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12052 IMPERIAL HWY # 204
NORWALK CA
90650-3090
US

IV. Provider business mailing address

3538 TORRANCE BLVD UNIT 186
TORRANCE CA
90503-9504
US

V. Phone/Fax

Practice location:
  • Phone: 310-892-5812
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: