Provider Demographics
NPI:1457654782
Name:PENDER, MARINA TIFFANY (OTR)
Entity Type:Individual
Prefix:
First Name:MARINA
Middle Name:TIFFANY
Last Name:PENDER
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:
Other - Last Name:PENDER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:12431 MAGNOLIA ST
Mailing Address - Street 2:STE 200
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92841-3321
Mailing Address - Country:US
Mailing Address - Phone:714-539-3155
Mailing Address - Fax:888-475-5771
Practice Address - Street 1:2111 S EL CAMINO REAL
Practice Address - Street 2:STE 200
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054-9000
Practice Address - Country:US
Practice Address - Phone:760-729-5433
Practice Address - Fax:760-729-1764
Is Sole Proprietor?:No
Enumeration Date:2010-12-08
Last Update Date:2016-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5678225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist