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General NPI Number Information
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NPI Number | 1134077811
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Entity Type | Individual
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Provider Name | MARI TOMOMI WADA
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Gender | Female
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Dates
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Enumeration Date | 03/19/2026
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Last Update Date | 03/19/2026
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Provider Practice Location Address
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Address Line | 221 N SAN DIMAS AVE # 219
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City | SAN DIMAS
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State | CA
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Zip | 91773-2664
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Country | US
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Telephone | 909-519-8912
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Fax |
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Provider Business Mailing Address
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Address Line | 5702 THELMA AVE
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City | LA PALMA
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State | CA
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Zip | 90623-1547
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Country | US
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Telephone | 714-350-3523
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 28849
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License Number State | CA
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