Basic Information
Provider Information
NPI: 1336394899
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ANDRADE
FirstName: DIONNE
MiddleName: ACEBU
NamePrefix:  
NameSuffix:  
Credential: OCCUPATIONAL THERAPI
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 763 BREA TER
Address2:  
City: SUNNYVALE
State: CA
PostalCode: 940856203
CountryCode: US
TelephoneNumber: 3212761061
FaxNumber:  
Practice Location
Address1: 3801 MIRANDA AVE
Address2: PMRS
City: PALO ALTO
State: CA
PostalCode: 943041207
CountryCode: US
TelephoneNumber: 6504935000
FaxNumber:  
Other Information
ProviderEnumerationDate: 11/25/2008
LastUpdateDate: 11/25/2008
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
171W00000XOT 13229FLY Other Service ProvidersContractor 

No ID Information.


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