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General NPI Number Information
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NPI Number | 1548712011
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Entity Type | Individual
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Provider Name | JEFF DIMENGO OTR/L
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Gender | Male
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Dates
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Enumeration Date | 10/31/2016
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Last Update Date | 06/13/2019
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Provider Practice Location Address
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Address Line | 2425 GEARY BLVD
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City | SAN FRANCISCO
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State | CA
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Zip | 94115-3358
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Country | US
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Telephone | 415-833-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 140 GARDENSIDE DR APT 303
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City | SAN FRANCISCO
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State | CA
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Zip | 94131-1325
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Country | US
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Telephone | 330-990-2030
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 12507
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License Number State | CA
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