Provider Demographics
NPI:1104619733
Name:DE CECCO, MARK VINCENT
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:VINCENT
Last Name:DE CECCO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 CITRUS LN
Mailing Address - Street 2:
Mailing Address - City:LADERA RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:92694-1321
Mailing Address - Country:US
Mailing Address - Phone:949-285-4154
Mailing Address - Fax:
Practice Address - Street 1:25411 SEA BLUFFS DR
Practice Address - Street 2:
Practice Address - City:DANA POINT
Practice Address - State:CA
Practice Address - Zip Code:92629-2190
Practice Address - Country:US
Practice Address - Phone:949-541-2232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-27
Last Update Date:2025-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6252225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist