Healthcare Provider Details

I. General information

NPI: 1003865916
Provider Name (Legal Business Name): NEENA EILEEN BAKSHI OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 06/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8775 AERO DR SUITE 238
SAN DIEGO CA
92123-1792
US

IV. Provider business mailing address

484 SILVERY LN
EL CAJON CA
92020-2225
US

V. Phone/Fax

Practice location:
  • Phone: 858-571-0030
  • Fax:
Mailing address:
  • Phone: 619-444-7967
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number3231
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: