Basic Information
| Provider Information | |||||||||
| NPI: | 1710344890 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | VIRGIN | ||||||||
| FirstName: | CARLA | ||||||||
| MiddleName: | P | ||||||||
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| Credential: | OTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 25538 JANUARY DR APT B | ||||||||
| Address2: | |||||||||
| City: | TORRANCE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 905057945 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3104131565 | ||||||||
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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: | 01/20/2016 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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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 | 225XP0200X | 18162 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Pediatrics |
No ID Information.