Healthcare Provider Details

I. General information

NPI: 1215329065
Provider Name (Legal Business Name): MARIA KIEU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2015
Last Update Date: 03/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 ANDERSEN DR APT 1313
SAN RAFAEL CA
94901-3993
US

IV. Provider business mailing address

155 ANDERSEN DR APT 1313
SAN RAFAEL CA
94901-3993
US

V. Phone/Fax

Practice location:
  • Phone: 408-674-8920
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License Number42118
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: