Individual
SUSAN J NISSIM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
35 SANTIAGO WAY, SAN RAFAEL, CA 94903-1790
(415) 302-8643
Mailing address
35 SANTIAGO WAY, SAN RAFAEL, CA 94903-1790
(415) 302-8643
Taxonomy
Speciality
Code
Description
License number
State
225XG0600X
Gerontology Occupational Therapist
Primary
6516
CA
Other
Enumeration date
11/13/2024
Last updated
11/13/2024
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