Provider Demographics
NPI:1740532878
Name:NINO, DENVER ERIGUEL (OTD, OTR/L)
Entity type:Individual
Prefix:MR
First Name:DENVER
Middle Name:ERIGUEL
Last Name:NINO
Suffix:
Gender:M
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12540 OAKCREEK LN
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-2042
Mailing Address - Country:US
Mailing Address - Phone:562-921-5116
Mailing Address - Fax:562-926-3930
Practice Address - Street 1:12540 OAKCREEK LN
Practice Address - Street 2:
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-2042
Practice Address - Country:US
Practice Address - Phone:562-921-5116
Practice Address - Fax:562-926-3930
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-13
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9614225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist