Healthcare Provider Details

I. General information

NPI: 1851017164
Provider Name (Legal Business Name): ROMA LEE YBERA OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2022
Last Update Date: 10/18/2022
Certification Date: 10/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31386 SAN ANDREAS DR
UNION CITY CA
94587-2859
US

IV. Provider business mailing address

31386 SAN ANDREAS DR
UNION CITY CA
94587-2859
US

V. Phone/Fax

Practice location:
  • Phone: 510-331-5914
  • Fax:
Mailing address:
  • Phone: 510-331-5914
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT17130
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: