Provider Demographics
NPI:1578559258
Name:ANDRES, PAOLO BENITO BARRERA (OTR L)
Entity Type:Individual
Prefix:MR
First Name:PAOLO BENITO
Middle Name:BARRERA
Last Name:ANDRES
Suffix:
Gender:M
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 1:20548 VENTURA BLVD
Mailing Address - Street 2:#111
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-6225
Mailing Address - Country:US
Mailing Address - Phone:818-888-3362
Mailing Address - Fax:
Practice Address - Street 1:10537 MAGNOLIA BLVD
Practice Address - Street 2:REHAB DEPT
Practice Address - City:N HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91601-4114
Practice Address - Country:US
Practice Address - Phone:818-508-9293
Practice Address - Fax:818-508-9293
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT658225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist