Provider Demographics
NPI:1245025485
Name:TAMBUNAN, BRENDA ULI CHRISTY (COTA)
Entity type:Individual
Prefix:
First Name:BRENDA ULI
Middle Name:CHRISTY
Last Name:TAMBUNAN
Suffix:
Gender:
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5120 SAN BERNARDINO ST APT 8
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:CA
Mailing Address - Zip Code:91763-2443
Mailing Address - Country:US
Mailing Address - Phone:909-545-7577
Mailing Address - Fax:
Practice Address - Street 1:140 S CHAPARRAL CT STE 160
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92808-2283
Practice Address - Country:US
Practice Address - Phone:714-794-5889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-10
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOTA7103224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant