Provider Demographics
NPI:1053696872
Name:ANILAO, CHARISSE ALBERT (OTR/L)
Entity type:Individual
Prefix:
First Name:CHARISSE
Middle Name:ALBERT
Last Name:ANILAO
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 MARDIGRAS CT
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-3041
Mailing Address - Country:US
Mailing Address - Phone:805-233-7355
Mailing Address - Fax:
Practice Address - Street 1:10730 HENDERSON RD
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93004-1832
Practice Address - Country:US
Practice Address - Phone:805-647-1141
Practice Address - Fax:805-647-1184
Is Sole Proprietor?:No
Enumeration Date:2011-10-12
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT6464174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist