Provider Demographics
NPI:1750447330
Name:CARDENAS, IGNACIO REMULLA JR (OTR-L)
Entity Type:Individual
Prefix:MR
First Name:IGNACIO
Middle Name:REMULLA
Last Name:CARDENAS
Suffix:JR
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 1:12109 BEVERLY DR
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90601-2702
Mailing Address - Country:US
Mailing Address - Phone:562-400-8386
Mailing Address - Fax:562-699-1989
Practice Address - Street 1:19141 BLOOMFIELD AVE
Practice Address - Street 2:
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-7104
Practice Address - Country:US
Practice Address - Phone:562-924-8837
Practice Address - Fax:562-924-3507
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2012-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT206225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA201548477OtherEIN
CA201548477OtherEIN