Provider Demographics
NPI:1285396820
Name:BUNDANG, NIKKI ARABELLE ETRATA (OTD, OTR/L)
Entity type:Individual
Prefix:
First Name:NIKKI ARABELLE
Middle Name:ETRATA
Last Name:BUNDANG
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2210 W SUNSET BLVD # 170
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90026-3002
Mailing Address - Country:US
Mailing Address - Phone:213-529-1870
Mailing Address - Fax:
Practice Address - Street 1:2322 S GARFIELD AVE
Practice Address - Street 2:
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91754-7220
Practice Address - Country:US
Practice Address - Phone:626-285-7337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-12
Last Update Date:2024-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21934225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics