Healthcare Provider Details

I. General information

NPI: 1619145661
Provider Name (Legal Business Name): MARIA THERESA MESINA OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2008
Last Update Date: 01/27/2020
Certification Date: 01/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 DIVISADERO ST STE 300
SAN FRANCISCO CA
94117-2242
US

IV. Provider business mailing address

2945 JUNIPERO SERRA BLVD
DALY CITY CA
94014-2549
US

V. Phone/Fax

Practice location:
  • Phone: 415-551-0975
  • Fax:
Mailing address:
  • Phone: 650-892-8881
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: