Provider Demographics
NPI:1770374795
Name:NUCUM, MARIA (OTR)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:NUCUM
Suffix:
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 1:76 VIA DEL CIELO
Mailing Address - Street 2:
Mailing Address - City:RANCHO PALOS VERDES
Mailing Address - State:CA
Mailing Address - Zip Code:90275-2510
Mailing Address - Country:US
Mailing Address - Phone:714-206-7597
Mailing Address - Fax:
Practice Address - Street 1:5801 CRESTRIDGE RD
Practice Address - Street 2:
Practice Address - City:RANCHO PALOS VERDES
Practice Address - State:CA
Practice Address - Zip Code:90275-4964
Practice Address - Country:US
Practice Address - Phone:877-727-3213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-16
Last Update Date:2025-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2730225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist