Healthcare Provider Details

I. General information

NPI: 1114222999
Provider Name (Legal Business Name): DISCHARGE RESOURCE GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2011
Last Update Date: 06/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 S BASCOM AVE SUITE 8
SAN JOSE CA
95128-3509
US

IV. Provider business mailing address

1150 S BASCOM AVE SUITE 8
SAN JOSE CA
95128-3509
US

V. Phone/Fax

Practice location:
  • Phone: 408-885-9000
  • Fax: 408-885-9009
Mailing address:
  • Phone: 408-885-9000
  • Fax: 408-885-9009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number10119
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number17648
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number5484
License Number StateCA

VIII. Authorized Official

Name: CAROL BLOCK
Title or Position: DIRECTOR
Credential: P.T.
Phone: 408-885-9000