Provider Demographics
NPI:1578170924
Name:NIPALES, JOHN PETER (OTR/L)
Entity Type:Individual
Prefix:MR
First Name:JOHN PETER
Middle Name:
Last Name:NIPALES
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:J.P.
Other - Middle Name:
Other - Last Name:NIPALES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR/L
Mailing Address - Street 1:17860 HOFFMAN AVE
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-2607
Mailing Address - Country:US
Mailing Address - Phone:760-333-8809
Mailing Address - Fax:
Practice Address - Street 1:1200 QUAIL ST STE 100
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2706
Practice Address - Country:US
Practice Address - Phone:949-475-1002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-29
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT21589225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist