Individual provider Active NPI

Marissa Padilla Gonzalez, OTR/L

  • Occupational Therapist
  • San Diego, CA
National Provider Identifier
1043920770
Registry record updated May 1, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
OT210002092 Issued in DC
Practice address
5643 Copley Dr Ste 230
San Diego, CA 92111-7903
Phone
(858) 302-5665
NPI assigned
Dec 5, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 1, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapist 225X00000X OT210002092 DC Primary

Addresses

Primary practice location

5643 Copley Dr Ste 230
San Diego, CA 92111-7903

Mailing address

5643 Copley Dr Ste 300
San Diego, CA 92111-7903
Phone (858) 455-9942

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241018001177 CA Practitioner - Occupational Therapist in Private Practice 8527590264 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Occupational Therapist in Private Practice
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mission Occupational and Hand Therapy Services ApcGroup PAC ID 8123431038, 3 clinicians
Ortho 1 Medical GroupGroup PAC ID 0042619876, 18 clinicians

Practice addresses (Care Compare)

12386 Sycamore Ridge CT
San Diego, CA 92131-3227
Phone (858) 761-8101

5643 Copley Dr
Suite 230
San Diego, CA 92111-7903
Phone (858) 302-5665

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
OT210002092DCMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Ortho 1 Medical Group CurrentSince Sep 1, 2024 Accepting new patients
Mission Occupational and Hand Therapy Services Apc CurrentSince Feb 16, 2026 Accepting new patients
Emily Jeter Otrl MSPT CHT Inc Occupational Therapist PastSince Mar 26, 2023 Accepting new patients

Locations

9834 Genesee Ave
Ste 228
La Jolla, CA 92037
Phone (858) 455-9942

5643 Copley Dr
Ste 230
San Diego, CA 92111
Phone (858) 302-5665

9988 Hibert St
Ste 208
San Diego, CA 92131
Phone (858) 227-7229

5643 Copley Dr
Ste 300
San Diego, CA 92111
Phone (858) 455-9942

230 Prospect Pl
Ste 230
San Diego, CA 92118
Phone (619) 435-7282

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1670198400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1746057600000",
    "number": "1043920770",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5643 COPLEY DR STE 300",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921117903",
            "telephone_number": "858-455-9942",
            "fax_number": "858-455-6473"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5643 COPLEY DR STE 230",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921117903",
            "telephone_number": "858-302-5665"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GONZALEZ",
        "first_name": "MARISSA",
        "middle_name": "PADILLA",
        "credential": "OTR/L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-12-05",
        "last_updated": "2025-05-01",
        "certification_date": "2025-05-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "DC",
            "license": "OT210002092",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.