Healthcare Provider Details

I. General information

NPI: 1437338027
Provider Name (Legal Business Name): CALIFORNIA PEDIATRIC THERAPY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2007
Last Update Date: 11/01/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1962 ANNANDALE WAY
POMONA CA
91767-3514
US

IV. Provider business mailing address

1962 ANNANDALE WAY
POMONA CA
91767-3514
US

V. Phone/Fax

Practice location:
  • Phone: 909-624-3015
  • Fax: 909-624-3015
Mailing address:
  • Phone:
  • Fax: 909-624-3015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License NumberPD1266
License Number StateCA

VIII. Authorized Official

Name: DENNIS NECESITO
Title or Position: PRESIDENT/CEO
Credential: OTR/L
Phone: 909-624-3015