Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225XG0600X | Occupational Therapist - Gerontology | ||
Y | 225XP0200X | Occupational Therapist - Pediatrics |
NPI | 1174006886 |
---|---|
Provider Name | Andrea Sosa |
First Address | Petaluma, CA 94954-3614 |
Second Address | San Rafael, CA 94903-2702 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/09/2018 |
Last Update Date | 09/09/2018 |