Provider Demographics
NPI:1205661220
Name:TINY TRIUMPHS PEDIATRIC OT
Entity type:Organization
Organization Name:TINY TRIUMPHS PEDIATRIC OT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ZAIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:PENALOZA
Authorized Official - Suffix:
Authorized Official - Credentials:MS, OTR/L
Authorized Official - Phone:323-402-3626
Mailing Address - Street 1:1613 CHELSEA RD STE 844
Mailing Address - Street 2:
Mailing Address - City:SAN MARINO
Mailing Address - State:CA
Mailing Address - Zip Code:91108-2419
Mailing Address - Country:US
Mailing Address - Phone:626-289-0102
Mailing Address - Fax:
Practice Address - Street 1:1045 S PINE ST
Practice Address - Street 2:
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91776-3136
Practice Address - Country:US
Practice Address - Phone:323-402-3626
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-09
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty