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General NPI Number Information
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NPI Number | 1215849989
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Entity Type | Individual
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Provider Name | LYDIA KIM-DELA FUENTE OTR/L
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Gender | Female
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Dates
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Enumeration Date | 09/18/2026
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Last Update Date | 09/18/2026
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Provider Practice Location Address
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Address Line | 15110 PARAMOUNT BLVD
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City | PARAMOUNT
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State | CA
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Zip | 90723-4337
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Country | US
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Telephone | 951-588-9661
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Fax |
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Provider Business Mailing Address
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Address Line | 11211 CANDOR ST
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City | CERRITOS
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State | CA
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Zip | 90703-6521
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Country | US
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Telephone |
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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 | 28669
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License Number State | CA
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