Provider Demographics
NPI:1083415285
Name:PADUA, ANDRE RAFALLO (COTA/L)
Entity type:Individual
Prefix:
First Name:ANDRE
Middle Name:RAFALLO
Last Name:PADUA
Suffix:
Gender:
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 1:7979 BYXBEE CT
Mailing Address - Street 2:
Mailing Address - City:EASTVALE
Mailing Address - State:CA
Mailing Address - Zip Code:92880-3248
Mailing Address - Country:US
Mailing Address - Phone:951-751-1760
Mailing Address - Fax:
Practice Address - Street 1:7979 BYXBEE CT
Practice Address - Street 2:
Practice Address - City:EASTVALE
Practice Address - State:CA
Practice Address - Zip Code:92880-3248
Practice Address - Country:US
Practice Address - Phone:951-751-1760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-24
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3571224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant