Individual
AYAKO OTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
901 EL CAMINO REAL, SAN BRUNO, CA 94066-3009
(650) 742-2100
Mailing address
3028 MASON LN, SAN MATEO, CA 94403-3243
(626) 423-8396
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
302869
CA
Other
Enumeration date
10/03/2022
Last updated
01/23/2023
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