Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 4017 | CA |
NPI | 1003120551 |
---|---|
Provider Name | Ethel-Grace Victoria |
First Address | San Jose, CA 95131-3900 |
Second Address | Sunnyvale, CA 94087-2440 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2010 |
Last Update Date | 27/07/2010 |