Healthcare Provider Details

I. General information

NPI: 1275690984
Provider Name (Legal Business Name): DERYKE AND ASSOCIATES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 08/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 E HAMILTON AVE
CAMPBELL CA
95008
US

IV. Provider business mailing address

201 E HAMILTON AVE
CAMPBELL CA
95008-0206
US

V. Phone/Fax

Practice location:
  • Phone: 408-376-0900
  • Fax: 408-376-0886
Mailing address:
  • Phone: 408-376-0900
  • Fax: 408-376-0886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: SARAH DELORENZO
Title or Position: BILLING MANGER
Credential:
Phone: 408-376-0900