Healthcare Provider Details

I. General information

NPI: 1891629358
Provider Name (Legal Business Name): PATRICK NGUYEN LUU OTR/L
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 GATEWAY PL STE 230E
SAN JOSE CA
95110-3719
US

IV. Provider business mailing address

2508 MONTE LINDO CT
SAN JOSE CA
95121-1259
US

V. Phone/Fax

Practice location:
  • Phone: 408-441-0740
  • Fax:
Mailing address:
  • Phone: 408-309-9429
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number23401
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number23401
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: