Healthcare Provider Details

I. General information

NPI: 1003107046
Provider Name (Legal Business Name): RIA RESURRECCION CAMERINO OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2011
Last Update Date: 04/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 N ROCKY POINT DR #650
TAMPA FL
33607-5917
US

IV. Provider business mailing address

21 FLOWERBUD
IRVINE CA
92603-0608
US

V. Phone/Fax

Practice location:
  • Phone: 800-892-0640
  • Fax:
Mailing address:
  • Phone: 949-294-6697
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT 2751
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: