Healthcare Provider Details

I. General information

NPI: 1619620630
Provider Name (Legal Business Name): KATRINA CUENCA-NARIO MOT, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2022
Last Update Date: 01/31/2022
Certification Date: 01/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12419 RODEO DR
RANCHO CUCAMONGA CA
91739-9599
US

IV. Provider business mailing address

12419 RODEO DR
RANCHO CUCAMONGA CA
91739-9599
US

V. Phone/Fax

Practice location:
  • Phone: 909-728-7889
  • Fax:
Mailing address:
  • Phone: 909-728-7889
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number15816
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: