Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 12609 | CA |
NPI | 1003282104 |
---|---|
Provider Name | Marjereen Mirabueno |
First Address | San Jose, CA 95111-2417 |
Second Address | San Jose, CA 95111-2417 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2015 |
Last Update Date | 12/08/2015 |