Provider Demographics
NPI:1902561731
Name:CARONAN, CYRENE MARI (COTA/L)
Entity Type:Individual
Prefix:MS
First Name:CYRENE
Middle Name:MARI
Last Name:CARONAN
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1248 W PARK WESTERN DR UNIT 44
Mailing Address - Street 2:
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90732-2280
Mailing Address - Country:US
Mailing Address - Phone:310-308-8871
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:90275-4961
Practice Address - Country:US
Practice Address - Phone:877-582-0153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-05
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5764224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant