MEDICARE: ROGELIO ESPARZA DIAZ OT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	25829	CA

General Provider Information

NPI Number	:	1215707427
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROGELIO ESPARZA DIAZ OT

Provider Business Mailing Address
First Line	:	6436 CRESTVIEW CIR
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95219-7198
Country	:	US
Telephone Number	:	209-487-2697
Fax Number	:

Provider Business Practice Location Address
First Line	:	3110 WAGNER HEIGHTS RD
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95209-4848
Country	:	US
Telephone Number	:	209-956-3444
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/08/2024
Last Update Date	:	01/08/2024

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