Healthcare Provider Details

I. General information

NPI: 1538983093
Provider Name (Legal Business Name): LIANA MAE LUGTU ATIZADO OTD, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/12/2024
Last Update Date: 06/20/2026
Certification Date: 06/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 QUALITY DR
VACAVILLE CA
95688-9494
US

IV. Provider business mailing address

460 MOUNT VERNON CIR
VACAVILLE CA
95688-9495
US

V. Phone/Fax

Practice location:
  • Phone: 707-624-2550
  • Fax:
Mailing address:
  • Phone: 510-230-9527
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number27142
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: