Healthcare Provider Details

I. General information

NPI: 1952879348
Provider Name (Legal Business Name): VICTORIA THI VU OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: VICTORIA VU OTR/L

II. Dates (important events)

Enumeration Date: 11/05/2018
Last Update Date: 07/28/2022
Certification Date: 07/28/2022
Deactivation Date: 07/18/2019
Reactivation Date: 07/28/2022

III. Provider practice location address

911 BERN CT STE 140
SAN JOSE CA
95112-1242
US

IV. Provider business mailing address

911 BERN CT STE 140
SAN JOSE CA
95112-1242
US

V. Phone/Fax

Practice location:
  • Phone: 408-573-7720
  • Fax: 844-789-4011
Mailing address:
  • Phone: 408-573-7720
  • Fax: 844-789-4011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number23774
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: