Provider Demographics
NPI:1679030027
Name:DAVID, MARIA ANNA LEAH MONCADA (OTR)
Entity Type:Individual
Prefix:
First Name:MARIA ANNA LEAH
Middle Name:MONCADA
Last Name:DAVID
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5024 STETSON ST
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95747-9639
Mailing Address - Country:US
Mailing Address - Phone:650-303-3348
Mailing Address - Fax:
Practice Address - Street 1:5024 STETSON ST
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95747-9639
Practice Address - Country:US
Practice Address - Phone:650-303-3348
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-21
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18174225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC010000667OtherHRLA BOARD OF OCCUPATIONAL THERAPY
MD264771OtherNBCOT
CA18174OtherCALIFORNIA BOARD OF OCCUPATIONAL THERAPY