Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 19565 | CA |
NPI | 1316599087 |
---|---|
Provider Name | Ajay Pala |
First Address | San Jose, CA 95130-1044 |
Second Address | Saratoga, CA 95130 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2019 |
Last Update Date | 12/07/2019 |