Healthcare Provider Details

I. General information

NPI: 1154240216
Provider Name (Legal Business Name): ISABELE MAGBANUA OTD, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2730 WILSHIRE BLVD STE 105
SANTA MONICA CA
90403-4724
US

IV. Provider business mailing address

171 W 223RD ST APT 6
CARSON CA
90745-3734
US

V. Phone/Fax

Practice location:
  • Phone: 310-984-5222
  • Fax:
Mailing address:
  • Phone: 310-717-8344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number29308
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: