Healthcare Provider Details

I. General information

NPI: 1215854674
Provider Name (Legal Business Name): KYEDDA IZZABELLA SOBEJANA GABUAT OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1911 OAK PARK BLVD
PLEASANT HILL CA
94523-4601
US

IV. Provider business mailing address

887 SAINT JOHN CIR
CONCORD CA
94518-2144
US

V. Phone/Fax

Practice location:
  • Phone: 925-935-6630
  • Fax:
Mailing address:
  • Phone: 925-435-8523
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number29197
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: