Provider Demographics
NPI:1316922594
Name:OKUBO, RONALD OKIO (OT)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:OKIO
Last Name:OKUBO
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 LAGUNA RD
Mailing Address - Street 2:STE. B
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-3634
Mailing Address - Country:US
Mailing Address - Phone:714-871-0460
Mailing Address - Fax:714-871-5342
Practice Address - Street 1:101 LAGUNA RD
Practice Address - Street 2:STE. B
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-3634
Practice Address - Country:US
Practice Address - Phone:714-871-0460
Practice Address - Fax:714-871-5342
Is Sole Proprietor?:No
Enumeration Date:2005-12-12
Last Update Date:2013-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT2818225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWP17058Medicare UPIN