Individual
JERROD D PAULO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OTR/L, CHT
Contact information
Practice address
13690 E 14TH ST, SUITE 200, SAN LEANDRO, CA 94578-2582
(510) 895-5511
(510) 895-5513
Mailing address
13690 E 14TH ST, SUITE 200, SAN LEANDRO, CA 94578-2582
(510) 895-5511
(510) 895-5513
Taxonomy
Speciality
Code
Description
License number
State
225XH1200X
Hand Occupational Therapist
Primary
OT 2258
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ZZZ04670Z
BLUESHIELD PROVIDER #
CA
01
—
ZZZ31058Z
PROVIDER TRANSACTION ACCESS NUMBER
CA
Enumeration date
01/30/2006
Last updated
05/07/2008
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