Provider Demographics
NPI:1740651744
Name:LARANANG, SHELLY (COTA)
Entity type:Individual
Prefix:
First Name:SHELLY
Middle Name:
Last Name:LARANANG
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:SHELLY
Other - Middle Name:
Other - Last Name:ACEBEDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3341 E 61ST ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90805-3803
Mailing Address - Country:US
Mailing Address - Phone:310-977-4996
Mailing Address - Fax:
Practice Address - Street 1:3341 E 61ST ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90805-3803
Practice Address - Country:US
Practice Address - Phone:310-977-4996
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-15
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3312224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant