Provider Demographics
NPI:1164557773
Name:NGUYEN, ROSABELLE LOAN (OTR/L)
Entity Type:Individual
Prefix:
First Name:ROSABELLE
Middle Name:LOAN
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1140 W. LA VETA AVENUE
Mailing Address - Street 2:SUITE 860
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-4218
Mailing Address - Country:US
Mailing Address - Phone:714-835-6500
Mailing Address - Fax:714-541-6105
Practice Address - Street 1:1140 W. LA VETA AVENUE
Practice Address - Street 2:SUITE 860
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4218
Practice Address - Country:US
Practice Address - Phone:714-835-6500
Practice Address - Fax:714-541-6105
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT9205225X00000X, 225XH1200X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOT0092050OtherBLUE SHIELD PIN
CAQ44795Medicare UPIN
CAWOT9205AMedicare PIN