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General NPI Number Information
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NPI Number | 1386843290
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Entity Type | Individual
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Provider Name | LORDELE PATO DE LOS REYES OTR/L
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Gender | Female
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Dates
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Enumeration Date | 07/12/2007
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Last Update Date | 07/12/2007
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Provider Practice Location Address
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Address Line | 12072 TRASK AVE
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City | GARDEN GROVE
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State | CA
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Zip | 92843-3821
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Country | US
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Telephone | 714-534-1942
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Fax |
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Provider Business Mailing Address
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Address Line | 10122 ALBEE AVE
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City | TUSTIN
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State | CA
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Zip | 92782-1439
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Country | US
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Telephone | 646-546-3825
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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 | 8635
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License Number State | CA
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