Provider Demographics
NPI:1447640693
Name:PARRA, IAN CHRISTOPHER SO
Entity type:Individual
Prefix:
First Name:IAN CHRISTOPHER
Middle Name:SO
Last Name:PARRA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 WASHINGTON HEIGHTS RD UNIT 23
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92019-3088
Mailing Address - Country:US
Mailing Address - Phone:619-362-5391
Mailing Address - Fax:
Practice Address - Street 1:725 WASHINGTON HEIGHTS RD UNIT 23
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92019-3088
Practice Address - Country:US
Practice Address - Phone:619-362-5391
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-27
Last Update Date:2025-03-04
Deactivation Date:2020-03-17
Deactivation Code:
Reactivation Date:2020-04-08
Provider Licenses
StateLicense IDTaxonomies
CA2425224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA8326201-01OtherSIGNATUREVALUE ALLIANCE HMO