Healthcare Provider Details

I. General information

NPI: 1912394321
Provider Name (Legal Business Name): SELGA RUZZANO MS, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SELGA RUZZANO MS, OTR/L

II. Dates (important events)

Enumeration Date: 04/23/2015
Last Update Date: 04/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 VIA LA CIRCULA
REDONDO BEACH CA
90277-6405
US

IV. Provider business mailing address

125 VIA LA CIRCULA
REDONDO BEACH CA
90277-6405
US

V. Phone/Fax

Practice location:
  • Phone: 310-968-2944
  • Fax:
Mailing address:
  • Phone: 310-968-2944
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number3761
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: