Provider Demographics
NPI:1942582168
Name:PRIETO, ROSE CAMILLE R (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:ROSE CAMILLE
Middle Name:R
Last Name:PRIETO
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MS
Other - First Name:ROSE CAMILLE
Other - Middle Name:V
Other - Last Name:ROBEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1251 E DYER RD STE 150
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-5662
Mailing Address - Country:US
Mailing Address - Phone:949-333-6400
Mailing Address - Fax:
Practice Address - Street 1:130 W VICTORIA ST
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90248-3523
Practice Address - Country:US
Practice Address - Phone:310-715-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-14
Last Update Date:2021-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12095225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist