Provider Demographics
NPI:1629529185
Name:CULAPAN-DY, MARIA ENELLIE VINZON (OTR/L)
Entity Type:Individual
Prefix:
First Name:MARIA ENELLIE
Middle Name:VINZON
Last Name:CULAPAN-DY
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 1:4707 CLARK AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90808-1102
Mailing Address - Country:US
Mailing Address - Phone:562-234-2175
Mailing Address - Fax:
Practice Address - Street 1:4707 CLARK AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90808-1102
Practice Address - Country:US
Practice Address - Phone:562-234-2175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-19
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6322225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist