Provider Demographics
NPI:1699145987
Name:YAN, KATRINA JEAN MONDEJAR (OTR/L)
Entity type:Individual
Prefix:MS
First Name:KATRINA JEAN
Middle Name:MONDEJAR
Last Name:YAN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:740 S. PACENTIA AVE.
Mailing Address - Street 2:STE 100
Mailing Address - City:PLACENTIA
Mailing Address - State:CA
Mailing Address - Zip Code:92870-6832
Mailing Address - Country:US
Mailing Address - Phone:714-646-8318
Mailing Address - Fax:714-646-8320
Practice Address - Street 1:740 S. PACENTIA AVE.
Practice Address - Street 2:STE 100
Practice Address - City:PLACENTIA
Practice Address - State:CA
Practice Address - Zip Code:92870-6832
Practice Address - Country:US
Practice Address - Phone:714-646-8318
Practice Address - Fax:714-646-8320
Is Sole Proprietor?:No
Enumeration Date:2015-09-30
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT15532225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist