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General NPI Number Information
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NPI Number | 1659706539
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Entity Type | Individual
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Provider Name | RENEE MARIE MORONES FABIAN OTR
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Gender | Female
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Dates
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Enumeration Date | 09/10/2013
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Last Update Date | 09/10/2013
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Provider Practice Location Address
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Address Line | 1947 CAMINO VIDA ROBLE SUITE 230
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City | CARLSBAD
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State | CA
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Zip | 92008-6540
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Country | US
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Telephone | 760-918-9500
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Fax |
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Provider Business Mailing Address
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Address Line | 359 SHORE VIEW LN
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City | ENCINITAS
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State | CA
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Zip | 92024-1761
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Country | US
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Telephone | 310-698-2178
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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 | OT7350
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 225XF0002X
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Taxonomy Name | Feeding, Eating & Swallowing Occupational Therapist
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License Number | OT7350
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | OT7350
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License Number State | CA
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