Mary Therese Etayeb, OTR

Primary specialty

Hand Occupational TherapistTaxonomy code 225XH1200X

License

5942 Issued in CA

Practice address

6041 Cadillac Ave
Los Angeles, CA 90034-1702

Phone

(323) 857-2536

Fax

(323) 857-3736

NPI assigned

Jun 29, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Specialty

Occupational Therapist in Private Practice

Education

Other, 1986

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Southern California Permanente Medical GroupGroup PAC ID 6002729175, 11,250 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Southern California Permanente Medical Group

  • Health Maintenance Organization
  • Baldwin Park, CA
  • NPI 1770515280
  Medicare reassignment Care Compare group NPD
• Southern California Permanente Medical Group

  • Health Maintenance Organization
  • Los Angeles, CA
  • NPI 1043242563
  NPD
• Southern California Permanente Medical Group

  • Health Maintenance Organization
  • Santa Clarita, CA
  • NPI 1316409410
  NPD

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

{
    "created_epoch": "1183075200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638489600000",
    "number": "1790982858",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6774 LA PRESA DR",
            "city": "SAN GABRIEL",
            "state": "CA",
            "postal_code": "917751108"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6041 CADILLAC AVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900341702",
            "telephone_number": "323-857-2536",
            "fax_number": "323-857-3736"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ETAYEB",
        "first_name": "MARY",
        "middle_name": "THERESE",
        "credential": "OTR",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-06-29",
        "last_updated": "2021-12-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225XH1200X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Hand",
            "state": "CA",
            "license": "5942",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "Southern California Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "4733 W Sunset Blvd",
            "city": "Los Angeles",
            "state": "CA",
            "country_code": "US",
            "postal_code": "900276021",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Eliot Musser Estrin
• Lucre'Ce Villamor Estropia, DO
• Carrie Joann Estuar, DNP, ARNP, FNP-C
• Elena Estwick
• Justina O. Esuola, DDS
• Ariel Etehad
• Shervin Alexander Etemad, MD
• Eternity Home Health Care, Inc.
• Kambiz Etesami, M.D.
• Neelou Shirin Etesami, MD, PHD

• Hand Occupational Therapist in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Hand Occupational Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2021; 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.