Healthcare Provider Details

I. General information

NPI: 1053685271
Provider Name (Legal Business Name): ERICA NICOLE ATLES YSLAS M.S., OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2012
Last Update Date: 03/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 HEMLOCK WAY STE 202
SANTA ANA CA
92707-3656
US

IV. Provider business mailing address

25 TANGLEWOOD LN
RANCHO SANTA MARGARITA CA
92688-5532
US

V. Phone/Fax

Practice location:
  • Phone: 714-656-2371
  • Fax:
Mailing address:
  • Phone: 949-933-3083
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number11463
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: