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General NPI Number Information
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NPI Number | 1225915606
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Entity Type | Individual
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Provider Name | CHANTYLLE PRADERA
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Gender | Female
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Dates
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Enumeration Date | 08/19/2025
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Last Update Date | 08/19/2025
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Provider Practice Location Address
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Address Line | 9900 INDIANA AVE STE 8
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City | RIVERSIDE
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State | CA
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Zip | 92503-5498
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Country | US
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Telephone | 951-376-1120
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Fax |
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Provider Business Mailing Address
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Address Line | 1026 W FEATHER RIVER WAY
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City | ORANGE
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State | CA
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Zip | 92865-2021
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Country | US
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Telephone | 714-616-7777
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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 | OT27965
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License Number State | CA
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