Provider Demographics
NPI:1174418149
Name:ALFONSO, CHRISZELLE NINA PALAD (COTA/L)
Entity type:Individual
Prefix:
First Name:CHRISZELLE NINA
Middle Name:PALAD
Last Name:ALFONSO
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 S BERENDO ST APT 303
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90020-2037
Mailing Address - Country:US
Mailing Address - Phone:213-926-2559
Mailing Address - Fax:
Practice Address - Street 1:330 S BERENDO ST APT 303
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90020-2037
Practice Address - Country:US
Practice Address - Phone:213-926-2559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-10
Last Update Date:2025-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6230224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant