Provider Demographics
NPI:1619425790
Name:VAISHNAV, ANGANA KALPESH (OTR/L)
Entity Type:Individual
Prefix:
First Name:ANGANA
Middle Name:KALPESH
Last Name:VAISHNAV
Suffix:
Gender:F
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 1:4215 ABNER ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90032-3639
Mailing Address - Country:US
Mailing Address - Phone:626-247-0521
Mailing Address - Fax:
Practice Address - Street 1:12881 KNOTT ST
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92841-3925
Practice Address - Country:US
Practice Address - Phone:714-892-6828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-16
Last Update Date:2016-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16634225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics