MEDICARE: MRS. MARJORIE VILLALOBOS LAROSA O.T.R/L

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
1	225X00000X	Occupational Therapist	11239	CA

General Provider Information

NPI Number	:	1619233483
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARJORIE VILLALOBOS LAROSA O.T.R/L

Provider Business Mailing Address
First Line	:	2644 MEATH DR
Second Line	:
City	:	SOUTH SAN FRANCISCO
State	:	CA
Zip	:	94080-3854
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2644 MEATH DR
Second Line	:
City	:	SOUTH SAN FRANCISCO
State	:	CA
Zip	:	94080-3854
Country	:	US
Telephone Number	:	650-534-8065
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/05/2012
Last Update Date	:	01/13/2022

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