Provider Demographics
NPI:1588929483
Name:NECESITO, DENNIS (OTD, OTR/L)
Entity type:Individual
Prefix:
First Name:DENNIS
Middle Name:
Last Name:NECESITO
Suffix:
Gender:M
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 1:630 S INDIAN HILL BLVD STE 5
Mailing Address - Street 2:
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711-5461
Mailing Address - Country:US
Mailing Address - Phone:213-618-9149
Mailing Address - Fax:
Practice Address - Street 1:630 S INDIAN HILL BLVD STE 5
Practice Address - Street 2:
Practice Address - City:CLAREMONT
Practice Address - State:CA
Practice Address - Zip Code:91711-5461
Practice Address - Country:US
Practice Address - Phone:909-451-8521
Practice Address - Fax:909-593-1211
Is Sole Proprietor?:No
Enumeration Date:2012-07-08
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7360225X00000X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7360OtherCALIFORNIA BOARD OF OCCUPATIONAL THERAPY