Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 796 | CA |
NPI | 1235468984 |
---|---|
Provider Name | Mr. John Maynarich |
First Address | San Francisco, CA 94122-3839 |
Second Address | San Francisco, CA 94122-3839 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/12/2009 |
Last Update Date | 09/12/2009 |