Provider Demographics
NPI:1861256190
Name:AVINA, SANDRA L (OT)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:L
Last Name:AVINA
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41204 REDHAWK ST
Mailing Address - Street 2:
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92203-3023
Mailing Address - Country:US
Mailing Address - Phone:760-625-2750
Mailing Address - Fax:866-225-9947
Practice Address - Street 1:69472 SERENITY RD
Practice Address - Street 2:
Practice Address - City:CATHEDRAL CITY
Practice Address - State:CA
Practice Address - Zip Code:92234-7921
Practice Address - Country:US
Practice Address - Phone:760-409-6383
Practice Address - Fax:866-225-9947
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-07
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT3790225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist