Provider Demographics
NPI:1568700532
Name:SANWO, MARISA YUMI (OTR)
Entity Type:Individual
Prefix:MS
First Name:MARISA
Middle Name:YUMI
Last Name:SANWO
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5139 MCCALLUM AVENUE
Mailing Address - Street 2:BACK UNIT
Mailing Address - City:SOUTH GATE
Mailing Address - State:CA
Mailing Address - Zip Code:90280-2426
Mailing Address - Country:US
Mailing Address - Phone:661-755-3872
Mailing Address - Fax:
Practice Address - Street 1:1731 W MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-1837
Practice Address - Country:US
Practice Address - Phone:714-778-5100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-24
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA16076225XG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program