Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XM0800X | Mental Health | OT10159 | CA |
NPI | 1669826491 |
---|---|
Provider Name | Michelle Urquidez |
First Address | San Jose, CA 95134-2108 |
Second Address | San Jose, CA 95134-2108 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2016 |
Last Update Date | 18/04/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
OT10159 | BOARD OF OCCUPATIONAL THERAPY (01) | CA |