Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XM0800X | Mental Health | OT 9308 | CA |
NPI | 1699106500 |
---|---|
Provider Name | Ursula Santamaria |
First Address | San Bruno, CA 94066-2513 |
Second Address | San Francisco, CA 94110-3518 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/12/2013 |
Last Update Date | 02/12/2013 |