Provider Demographics
NPI:1265105407
Name:ISIDRO, ZSIENNE ANTONETTE P (OTD, OTR)
Entity type:Individual
Prefix:
First Name:ZSIENNE ANTONETTE
Middle Name:P
Last Name:ISIDRO
Suffix:
Gender:F
Credentials:OTD, OTR
Other - Prefix:
Other - First Name:ANNE
Other - Middle Name:
Other - Last Name:ISIDRO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTD, OTR
Mailing Address - Street 1:349 BORDEN RD
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92069-5708
Mailing Address - Country:US
Mailing Address - Phone:951-437-1494
Mailing Address - Fax:
Practice Address - Street 1:10538 MISSION GORGE RD
Practice Address - Street 2:
Practice Address - City:SANTEE
Practice Address - State:CA
Practice Address - Zip Code:92071-3154
Practice Address - Country:US
Practice Address - Phone:619-312-6109
Practice Address - Fax:619-312-6110
Is Sole Proprietor?:No
Enumeration Date:2021-07-25
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist