Healthcare Provider Details

I. General information

NPI: 1356797468
Provider Name (Legal Business Name): NATALIE TAHARA OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2016
Last Update Date: 05/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 GREAT OAKS BLVD # 117
SAN JOSE CA
95119-1310
US

IV. Provider business mailing address

80 GREAT OAKS BLVD # 117
SAN JOSE CA
95119-1310
US

V. Phone/Fax

Practice location:
  • Phone: 408-363-3000
  • Fax:
Mailing address:
  • Phone: 408-363-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License NumberOT645
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: