Healthcare Provider Details

I. General information

NPI: 1306409628
Provider Name (Legal Business Name): KLAUDIA PARADI ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2019
Last Update Date: 04/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16615 LARK AVE
LOS GATOS CA
95032-7645
US

IV. Provider business mailing address

617 S 22ND ST
SAN JOSE CA
95116-3131
US

V. Phone/Fax

Practice location:
  • Phone: 408-358-1460
  • Fax:
Mailing address:
  • Phone: 510-926-8938
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberBOC352838
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: