Provider Demographics
NPI:1346815370
Name:NACIONALES, ANGELINA ROSE (OTR/L)
Entity type:Individual
Prefix:
First Name:ANGELINA ROSE
Middle Name:
Last Name:NACIONALES
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4913 W 118TH ST
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250-2018
Mailing Address - Country:US
Mailing Address - Phone:310-735-7522
Mailing Address - Fax:
Practice Address - Street 1:4913 W 118TH ST
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-2018
Practice Address - Country:US
Practice Address - Phone:310-735-7522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-21
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22388225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist