Individual
MR. MARIANO JERVOSO MEMPIN III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
1604 BLOSSOM HILL RD STE 10, SAN JOSE, CA 95124-6350
(408) 528-8833
Mailing address
37171 SYCAMORE ST APT 625, NEWARK, CA 94560-3975
(707) 980-4219
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
52735
CA
Other
Enumeration date
03/06/2024
Last updated
03/06/2024
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