MEDICARE: REVATHY RANGANATHAN

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	224Z00000X	Occupational Therapy Assistant	4138	CA

General Provider Information

NPI Number	:	1760021315
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REVATHY RANGANATHAN

Provider Business Mailing Address
First Line	:	13636 RUNNING SPRINGS DR
Second Line	:
City	:	CHINO HILLS
State	:	CA
Zip	:	91709-1442
Country	:	US
Telephone Number	:	909-210-7302
Fax Number	:

Provider Business Practice Location Address
First Line	:	638 E COLORADO AVE
Second Line	:
City	:	GLENDORA
State	:	CA
Zip	:	91740-4422
Country	:	US
Telephone Number	:	626-963-6091
Fax Number	:

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

Provider Enumeration Date	:	12/30/2019
Last Update Date	:	12/31/2019

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Directions to “ REVATHY RANGANATHAN ” Practice Location

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