Healthcare Provider Details

I. General information

NPI: 1306399522
Provider Name (Legal Business Name): MANJIRI GOKHALE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2016
Last Update Date: 07/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 W PROVIDENCE AVE
ORANGE CA
92868-3808
US

IV. Provider business mailing address

1301 W PROVIDENCE AVE
ORANGE CA
92868-3808
US

V. Phone/Fax

Practice location:
  • Phone: 714-923-1527
  • Fax: 855-902-7742
Mailing address:
  • Phone: 714-923-1527
  • Fax: 855-902-7743

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT 3527
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: