Provider Demographics
NPI:1043369838
Name:TANNA, NILIMA NIHAR (OTR L, CLVT)
Entity Type:Individual
Prefix:
First Name:NILIMA
Middle Name:NIHAR
Last Name:TANNA
Suffix:
Gender:F
Credentials:OTR L, CLVT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27035 BIG HORN MOUNTAIN WAY
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92887-4211
Mailing Address - Country:US
Mailing Address - Phone:909-348-7590
Mailing Address - Fax:
Practice Address - Street 1:27035 BIG HORN MOUNTAIN WAY
Practice Address - Street 2:
Practice Address - City:YORBA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92887
Practice Address - Country:US
Practice Address - Phone:909-348-7590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA96-9755225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOT0073820OtherBLUE SHIELD PIN
CAOT7382Medicare ID - Type UnspecifiedMEDICARE PPIN