Healthcare Provider Details

I. General information

NPI: 1821347014
Provider Name (Legal Business Name): CHARLOTTE DENG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2012
Last Update Date: 01/26/2023
Certification Date: 01/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 OAK GROVE AVE STE A102
MENLO PARK CA
94025-4427
US

IV. Provider business mailing address

849 MENLO AVE
MENLO PARK CA
94025-4728
US

V. Phone/Fax

Practice location:
  • Phone: 650-323-0805
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number14009
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: