Healthcare Provider Details

I. General information

NPI: 1083887699
Provider Name (Legal Business Name): HILDELISA HARO LARIOS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2008
Last Update Date: 04/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 SOUTH RAYMOND AVE SUITE 120
PASADENA CA
91105
US

IV. Provider business mailing address

630 SOUTH RAYMOND AVE SUITE 120
PASADENA CA
91105
US

V. Phone/Fax

Practice location:
  • Phone: 626-403-1444
  • Fax: 626-403-1448
Mailing address:
  • Phone: 626-403-1444
  • Fax: 626-403-1448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT 9087
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: