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NPI Code Detail

MEDICARE: MS. CAROL L SAN OT

MEDICARE: MS. CAROL L SAN OT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program
2225X00000XOccupational Therapist11145CA

General Provider Information

NPI Number : 1518115260
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. CAROL L SAN OT
Provider Business Mailing Address
First Line : 20090 STANTON AVE
Second Line :
City : CASTRO VALLEY
State : CA
Zip : 94546-5203
Country : US
Telephone Number : 510-538-8464
Fax Number :
Provider Business Practice Location Address
First Line : 20090 STANTON AVE
Second Line :
City : CASTRO VALLEY
State : CA
Zip : 94546-5203
Country : US
Telephone Number : 510-538-8464
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/07/2008
Last Update Date : 02/27/2023

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