Provider Demographics
NPI:1184103160
Name:ACTION DIVERSIFIED INC.
Entity type:Organization
Organization Name:ACTION DIVERSIFIED INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:C
Authorized Official - Last Name:BRONNER
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:949-394-6587
Mailing Address - Street 1:17595 HARVARD AVE STE C2230
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92614-8516
Mailing Address - Country:US
Mailing Address - Phone:949-394-6587
Mailing Address - Fax:
Practice Address - Street 1:65 LONG MDW
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92620-2825
Practice Address - Country:US
Practice Address - Phone:949-394-6587
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-09
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9591225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty