Active NPI
Jessica Gardenia Vajarakitipongse, OTR
- Occupational Therapist
- Corona, CA
National Provider Identifier
1982039970
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 11386
- Practice address
- 2815 S Main St Ste 205
Corona, CA 92882-2533 - Phone
- (951) 475-1307
- Fax
- (951) 475-1308
- NPI assigned
- Sep 9, 2013
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 11386 | CA | Primary |
Addresses
Primary practice location
2815 S Main St Ste 205
Corona, CA 92882-2533
Mailing address
747 Lassen Dr
Corona, CA 92879-5980
Phone (951) 751-8612
Other names 1
- Jessica Gardenia Abad
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1378684800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1556064000000",
"number": "1982039970",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "747 LASSEN DR",
"city": "CORONA",
"state": "CA",
"postal_code": "928795980",
"telephone_number": "951-751-8612"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2815 S MAIN ST STE 205",
"city": "CORONA",
"state": "CA",
"postal_code": "928822533",
"telephone_number": "951-475-1307",
"fax_number": "951-475-1308"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VAJARAKITIPONGSE",
"first_name": "JESSICA",
"middle_name": "GARDENIA",
"credential": "OTR",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-09-09",
"last_updated": "2019-04-24",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "CA",
"license": "11386",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "JESSICA",
"last_name": "ABAD",
"middle_name": "GARDENIA",
"credential": "OTR",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Corona, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.