Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | 4425 | CA |
N | 2251E1200X | Ergonomics | 4425 | CA |
N | 225XE1200X | Ergonomics | 4425 | CA |
N | 225XG0600X | Occupational Therapist - Gerontology | 4425 | CA |
N | 225XH1200X | Occupational Therapist - Hand | 4425 | CA |
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | 4425 | CA |
NPI | 1982676151 |
---|---|
Provider Name | Mr. Jose Amer Se De Juan |
First Address | South San Francisco, CA 94080-2452 |
Second Address | South San Francisco, CA 94080-2452 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2006 |
Last Update Date | 10/11/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4425 | CALIFORNIA BOARD OF OT (01) | CA |
562 | NEURO-IFRAH CERTIFIED (01) | CA |
985705 | NBCOT-OTR/L (01) | CA |