Healthcare Provider Details

I. General information

NPI: 1023617248
Provider Name (Legal Business Name): MARIELLA YSOBEL ROMERO TIMBANG OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2020
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16320 ROSCOE BLVD
VAN NUYS CA
91406-1250
US

IV. Provider business mailing address

423 IMPERIAL HWY
FULLERTON CA
92835-1146
US

V. Phone/Fax

Practice location:
  • Phone: 818-894-2273
  • Fax: 818-357-2505
Mailing address:
  • Phone: 714-465-4777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number21668
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: