CENTRA PEDIATRIC THERAPY (NPI# 1902177025) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1902177025 |
| Entity Type | Organization |
| Organization Name | CENTRA PEDIATRIC THERAPY |
| Practice Address |
3002 Dow Ave Ste 114 Tustin CA 92780-7247 |
| Mailing Address |
3002 Dow Ave #114 Tustin CA 92780-7236 |
| Practice Telephone | 7147314668 |
| Practice Fax Number | 7144644668 |
| Mailing Telephone | 7147314668 |
| Mailing Fax Number | 7144644668 |
| Enumeration Date | 2012-01-20 |
| Last Update Date | 2014-07-14 |
| Authorized Official Name | MR. WAYNE BRIAN CENTRA (OWNER/OCCUPATIONAL THERAPIST) |
| Authorized Official Telephone | 7147314668 |
| Authorized Official Credential | OT |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 261QH0700X |
Clinic/Center Specialization: Hearing and Speech |
Ambulatory Health Care Facilities | ||
| N | 261QP2000X |
Clinic/Center Specialization: Physical Therapy |
Ambulatory Health Care Facilities | ||
| Y | 261QX0100X |
Clinic/Center Specialization: Occupational Medicine |
Ambulatory Health Care Facilities |
| Street Address |
3002 DOW AVE STE 114 |
| City | TUSTIN |
| State | CA |
| Zip Code | 92780-7247 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962000893 | Rachel N Van Vliet | Speech-Language Pathologist | 3002 Dow Ave Ste 114, Tustin, CA 92780-7247 | 2020-10-13 |
| 1255971990 | Emily Ann Davidson | Speech-Language Pathologist | 3002 Dow Ave Ste 114, Tustin, CA 92780-7247 | 2020-01-10 |
| 1912476557 | Jordan Holzer | Clinic/Center | 3002 Dow Ave Ste 114, Tustin, CA 92780-7247 | 2018-11-13 |
| 1760971519 | Dorothy Uong | Occupational Therapist | 3002 Dow Ave Ste 114, Tustin, CA 92780-7247 | 2018-05-08 |
| 1588101281 | Rachel Immel | Occupational Therapist | 3002 Dow Ave Ste 114, Tustin, CA 92780-7247 | 2017-01-20 |
| 1457726788 | Kathleen Boggan Zierhut | Speech-Language Pathologist | 3002 Dow Ave Ste 114, Tustin, CA 92780-7247 | 2015-12-11 |
| 1548635832 | Brittany Megan Thompson | Occupational Therapist | 3002 Dow Ave Ste 114, Tustin, CA 92780-7247 | 2015-12-11 |
| 1477891448 | Iris Lin | Occupational Therapist | 3002 Dow Ave Ste 114, Tustin, CA 92780 | 2013-01-24 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437780947 | John Michael Michael | Pharmacist | 14481 Wildeve Ln, Tustin, CA 92780 | 2020-02-03 |
| 1609426881 | Abigail Joy Maqsood | Behavior Technician | 290a S Prospect Ave, Tustin, CA 92780 | 2019-09-19 |
| 1255814711 | Hyun Dong Lee | Chiropractor | 14591 Newport Ave Ste 106, Tustin, CA 92780 | 2018-09-11 |
| 1346733573 | Elizabeth Kim Nguyen Dds Inc | Clinic/Center | 14521 Red Hill Ave, Tustin, CA 92780 | 2018-06-12 |
| 1255829503 | Hw Physical Therapy | Physical Therapist | 250 El Camino Real Ste 100, Tustin, CA 92780 | 2018-04-23 |
| 1912494352 | Gary Wayne Mcbeath | Marriage & Family Therapist | 17821 E 17th Street, Suite # 260, Tustin, CA 92780 | 2018-04-20 |
| 1104334598 | Catherine Bogues | Speech-Language Pathologist | 661 West 1st Street, Suite E, Tustin, CA 92780 | 2018-01-19 |
| 1972019941 | Lighthouse Behavioral Solutions | Behavioral Analyst | 18002 Irvine Blvd., Suite 202c, Tustin, CA 92780 | 2017-12-28 |
| 1629597299 | Lifecab, LLC | Non-emergency Medical Transport (VAN) | 13732 Newport Ave, Suite #1, Tustin, CA 92780 | 2017-09-14 |
| 1437606555 | Tustin Speech Therapy, Inc. | Speech-Language Pathologist | 661 West First Street, Suite E, Tustin, CA 92780 | 2016-09-07 |
| Find all providers in zip 92780 | ||||
| Taxonomy Code | 261QX0100X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Occupational Medicine |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912476557 | Jordan Holzer | Clinic/Center | 3002 Dow Ave Ste 114, Tustin, CA 92780-7247 | 2018-11-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720688708 | Kings Industrial Occupational Medical Center Inc | Clinic/Center | 936 G St Ste B, Reedley, CA 93654-2627 | 2020-10-28 |
| 1467067280 | Michael Scott Weiner | Clinic/Center | 2388 Ginger Cir, Newbury Park, CA 91320-3349 | 2020-09-09 |
| 1790396547 | Oak Valley Hospital District | Clinic/Center | 250 S Oak Ave Ste A4, Oakdale, CA 95361-3572 | 2020-08-14 |
| 1013543693 | Healthworks Med Group of California A Medical Corporation | Clinic/Center | 3600 Juliette Ln # Sr9-01, Santa Clara, CA 95054-1540 | 2020-03-16 |
| 1386287878 | Starlight Therapy Center Inc | Clinic/Center | 1235 Indiana Ct Ste 107, Redlands, CA 92374-4540 | 2019-10-28 |
| 1356819924 | Unete Healthcare Associates LLC | Clinic/Center | 928 S Broadway Apt 813, Los Angeles, CA 90015-4578 | 2018-11-13 |
| 1669956710 | Sacramento Occupational Medical Center | Clinic/Center | 3840 Watt Ave., Number B, Sacramento, CA 95821-2640 | 2018-09-24 |
| 1487106217 | Imperial Valley Occupational Medicine | Clinic/Center | 1850 W Main St Ste E, El Centro, CA 92243-2106 | 2016-10-27 |
| 1306205570 | Blue Oak Medical Group | Clinic/Center | 4300 Long Beach Blvd Ste 170, Long Beach, CA 90807 | 2016-02-17 |
| 1225495203 | Blue Oak Medical Group | Clinic/Center | 10832 Laurel St Ste 102, Rancho Cucamonga, CA 91730 | 2016-01-22 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.