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General NPI Number Information
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NPI Number | 1205661220
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Entity Type | Organization
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Legal Business Name | TINY TRIUMPHS PEDIATRIC OT
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Dates
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Enumeration Date | 09/09/2024
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Last Update Date | 09/09/2024
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Provider Practice Location Address
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Address Line | 1045 S PINE ST
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City | SAN GABRIEL
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State | CA
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Zip | 91776-3136
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Country | US
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Telephone | 323-402-3626
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Fax |
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Provider Business Mailing Address
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Address Line | 1613 CHELSEA RD STE 844
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City | SAN MARINO
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State | CA
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Zip | 91108-2419
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Country | US
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Telephone | 626-289-0102
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | ZAIRA PENALOZA
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Credential | MS, OTR/L
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Telephone | 323-402-3626
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number |
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License Number State |
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