Provider Demographics
NPI:1043739469
Name:VINCUILLA, SHARON (MAOT, CPDT-KA)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:VINCUILLA
Suffix:
Gender:F
Credentials:MAOT, CPDT-KA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12948 MOORPARK ST APT 4
Mailing Address - Street 2:
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91604-5032
Mailing Address - Country:US
Mailing Address - Phone:323-774-4547
Mailing Address - Fax:
Practice Address - Street 1:12948 MOORPARK ST APT 4
Practice Address - Street 2:
Practice Address - City:STUDIO CITY
Practice Address - State:CA
Practice Address - Zip Code:91604-5032
Practice Address - Country:US
Practice Address - Phone:323-774-4547
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-18
Last Update Date:2017-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XM0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistMental Health