Individual
SURA SO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2501 ALVIN AVE, SAN JOSE, CA 95121-1660
(408) 238-9751
Mailing address
1479 CHERRY CIR, MILPITAS, CA 95035-3879
(213) 270-3071
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
4767
CA
Other
Enumeration date
09/06/2021
Last updated
09/06/2021
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