Provider Demographics
NPI:1417265216
Name:ANZAI, DONNA (OTR/L)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:ANZAI
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 1:22908 WREN STREET
Mailing Address - Street 2:
Mailing Address - City:GRAND TERRACE
Mailing Address - State:CA
Mailing Address - Zip Code:92313-5580
Mailing Address - Country:US
Mailing Address - Phone:800-644-2966
Mailing Address - Fax:909-363-8574
Practice Address - Street 1:33492 OAK GLEN RD
Practice Address - Street 2:SUITE H
Practice Address - City:YUCAIPA
Practice Address - State:CA
Practice Address - Zip Code:92399-2096
Practice Address - Country:US
Practice Address - Phone:909-767-5155
Practice Address - Fax:909-363-8574
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-15
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1680225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist