Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | CA |
NPI | 1407970213 |
---|---|
Provider Name | Mrs. Mary Ann Ocampo Ballesteros |
First Address | San Jose, CA 95136-3611 |
Second Address | San Jose, CA 95136-3611 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/03/2007 |
Last Update Date | 26/11/2021 |