Healthcare Provider Details

I. General information

NPI: 1679350482
Provider Name (Legal Business Name): ELISA CARRANZA OTD, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2023
Last Update Date: 09/14/2023
Certification Date: 09/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1815 W 213TH ST
TORRANCE CA
90501-2800
US

IV. Provider business mailing address

5127 W 140TH ST
HAWTHORNE CA
90250-6522
US

V. Phone/Fax

Practice location:
  • Phone: 310-328-0276
  • Fax:
Mailing address:
  • Phone: 310-955-8804
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number25412
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: