Individual provider Active NPI

Melissa Mattos De Unamuno, M.O.T.L.

  • Occupational Therapist
  • Fremont, CA
National Provider Identifier
1245256056
Registry record updated Feb 4, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
OT6637 Issued in CA
Practice address
3575 Beacon Ave
Fremont, CA 94538-1407
Phone
(510) 794-9672
Fax
(510) 792-8138
NPI assigned
Jul 14, 2006
Last updated
Feb 4, 2009By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 4, 2009

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 OT6637 CA Primary

Addresses

Primary practice location

3575 Beacon Ave
Fremont, CA 94538-1407

Mailing address

3575 Beacon Ave
Fremont, CA 94538-1407
Phone (510) 794-9672

Other identifiers 2

IdentifierTypeStateIssuer
OT0066370OtherCABLUE SHIELD OF CALIFORNIA
CT0066370MedicaidCA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060920000458 CA Practitioner - Occupational Therapist in Private Practice 5597760843 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Occupational Therapist in Private Practice
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

39141 Civic Ctr Dr
Suite 120
Fremont, CA 94538-5831
Phone (510) 794-9672

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
OT6637CAMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Washington Outpatient Rehabilitation Center, a Joint Venture CurrentSince Feb 1, 2006 Accepting new patients

Locations

3575 Beacon Ave
Fremont, CA 94538
Phone (510) 794-9672

39141 Civic Center Dr
Ste 120
Fremont, CA 94538
Phone (510) 794-9672

Organizations & group practices 1

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

NPI Registry JSON

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

{
    "created_epoch": "1152835200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1233705600000",
    "number": "1245256056",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3575 BEACON AVE",
            "city": "FREMONT",
            "state": "CA",
            "postal_code": "945381407",
            "telephone_number": "510-794-9672",
            "fax_number": "510-792-8138"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3575 BEACON AVE",
            "city": "FREMONT",
            "state": "CA",
            "postal_code": "945381407",
            "telephone_number": "510-794-9672",
            "fax_number": "510-792-8138"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DE UNAMUNO",
        "first_name": "MELISSA",
        "middle_name": "MATTOS",
        "name_prefix": "Mrs.",
        "credential": "M.O.T.L.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-14",
        "last_updated": "2009-02-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "CA",
            "license": "OT6637",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD OF CALIFORNIA",
            "identifier": "OT0066370",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "CT0066370",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fremont, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2009; 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.