Provider Demographics
NPI:1912394321
Name:RUZZANO, SELGA (MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:SELGA
Middle Name:
Last Name:RUZZANO
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:MS
Other - First Name:SELGA
Other - Middle Name:
Other - Last Name:RUZZANO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, OTR/L
Mailing Address - Street 1:125 VIA LA CIRCULA
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-6405
Mailing Address - Country:US
Mailing Address - Phone:310-968-2944
Mailing Address - Fax:
Practice Address - Street 1:125 VIA LA CIRCULA
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-6405
Practice Address - Country:US
Practice Address - Phone:310-968-2944
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-23
Last Update Date:2015-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3761225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist