Provider Demographics
NPI:1245457043
Name:MIJARES, CLARISA M (OTR)
Entity type:Individual
Prefix:MRS
First Name:CLARISA
Middle Name:M
Last Name:MIJARES
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3638 MOTOR AVE.
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90034-5702
Mailing Address - Country:US
Mailing Address - Phone:310-204-8999
Mailing Address - Fax:310-204-8916
Practice Address - Street 1:3638 MOTOR AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90034-5702
Practice Address - Country:US
Practice Address - Phone:310-204-8999
Practice Address - Fax:310-204-8916
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT 5085225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics