Healthcare Provider Details

I. General information

NPI: 1558293217
Provider Name (Legal Business Name): VANESSA CICCHINI
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2026
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 N CATALINA AVE STE 1300
REDONDO BEACH CA
90277-2190
US

IV. Provider business mailing address

5323 W 138TH ST
HAWTHORNE CA
90250-6429
US

V. Phone/Fax

Practice location:
  • Phone: 310-673-8412
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: