Basic Information
| Provider Information | |||||||||
| NPI: | 1508367988 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCDONALD | ||||||||
| FirstName: | BRENDA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 20101 WAYNE AVE | ||||||||
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| City: | TORRANCE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 905031246 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3109825725 | ||||||||
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| Practice Location | |||||||||
| Address1: | 12411 SLAUSON AVE STE G | ||||||||
| Address2: | |||||||||
| City: | WHITTIER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906062835 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5626935449 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/22/2018 | ||||||||
| LastUpdateDate: | 02/22/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 225XP0200X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Pediatrics |
No ID Information.