MEDICARE: LISA PHUONG-LINH VU MS, OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	OT21505	CA

General Provider Information

NPI Number	:	1316332919
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA PHUONG-LINH VU MS, OTR/L

Provider Business Mailing Address
First Line	:	9528 MIRAMAR RD # 1014
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92126-4533
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	13223 BLACK MOUNTAIN RD # 1358
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92129-2698
Country	:	US
Telephone Number	:	858-753-5082
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/31/2015
Last Update Date	:	10/06/2022

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