Individual
JEFF DIMENGO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OTR/L
Contact information
Practice address
2425 GEARY BLVD, SAN FRANCISCO, CA 94115-3358
(415) 833-2000
Mailing address
140 GARDENSIDE DR, APT 303, SAN FRANCISCO, CA 94131-1325
(330) 990-2030
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
12507
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12507
BOARD OF OCCUPATIONAL THERAPY
CA
Enumeration date
10/31/2016
Last updated
06/13/2019
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