Provider Demographics
NPI:1497959498
Name:BORRO, RAISSA SYBYLL PISON (OTR/L)
Entity Type:Individual
Prefix:
First Name:RAISSA SYBYLL
Middle Name:PISON
Last Name:BORRO
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:RAISSA SYBYLL
Other - Middle Name:DAQUILANEA
Other - Last Name:PISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:27442 PORTOLA PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:FOOTHILL RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:92610-2822
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2800 N HARBOR BLVD
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-1727
Practice Address - Country:US
Practice Address - Phone:714-871-9202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2014-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT 12976225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist