Provider Demographics
NPI:1386843290
Name:DE LOS REYES, LORDELE PATO (OTR/L)
Entity Type:Individual
Prefix:
First Name:LORDELE
Middle Name:PATO
Last Name:DE LOS REYES
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:LORDELE
Other - Middle Name:TRASPORTE
Other - Last Name:PATO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:10122 ALBEE AVE
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92782-1439
Mailing Address - Country:US
Mailing Address - Phone:646-546-3825
Mailing Address - Fax:
Practice Address - Street 1:12072 TRASK AVE
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843-3821
Practice Address - Country:US
Practice Address - Phone:714-534-1942
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-12
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8635225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist