Provider Demographics
NPI:1033779566
Name:FRUTO, JOANNA MARIE (OTR)
Entity Type:Individual
Prefix:
First Name:JOANNA MARIE
Middle Name:
Last Name:FRUTO
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41024 SUNSPRITE ST
Mailing Address - Street 2:
Mailing Address - City:LAKE ELSINORE
Mailing Address - State:CA
Mailing Address - Zip Code:92532-1556
Mailing Address - Country:US
Mailing Address - Phone:951-345-2900
Mailing Address - Fax:
Practice Address - Street 1:511 ENCINITAS BLVD STE 100
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-3778
Practice Address - Country:US
Practice Address - Phone:760-436-7344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-17
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA757618163W00000X
225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No163W00000XNursing Service ProvidersRegistered Nurse