Healthcare Provider Details

I. General information

NPI: 1386480846
Provider Name (Legal Business Name): JACQUELINE PILAR RAMIREZ OTD, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JACQUELINE PILAR MARIN

II. Dates (important events)

Enumeration Date: 07/03/2024
Last Update Date: 08/08/2024
Certification Date: 08/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2555 E COLORADO BLVD STE 100
PASADENA CA
91107-6617
US

IV. Provider business mailing address

11144 CREWE ST
NORWALK CA
90650-7801
US

V. Phone/Fax

Practice location:
  • Phone: 626-564-2100
  • Fax:
Mailing address:
  • Phone: 562-456-6335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number26600
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: