Provider Demographics
NPI:1619427176
Name:AMBRAZAITE, IEVA LUNA I (OTR)
Entity type:Individual
Prefix:
First Name:IEVA
Middle Name:LUNA
Last Name:AMBRAZAITE
Suffix:I
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 1:3003 N ARROYO DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-6118
Mailing Address - Country:US
Mailing Address - Phone:630-660-3636
Mailing Address - Fax:
Practice Address - Street 1:3003 N ARROYO DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-6118
Practice Address - Country:US
Practice Address - Phone:630-660-3636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-09
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15139225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty