Provider Demographics
NPI:1790940351
Name:RODRIGUEZ, MARILU ESCOBAR (MOT)
Entity Type:Individual
Prefix:
First Name:MARILU
Middle Name:ESCOBAR
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:MOT
Other - Prefix:
Other - First Name:MARILU
Other - Middle Name:
Other - Last Name:ESCOBAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:534 CALERO AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95123-3303
Mailing Address - Country:US
Mailing Address - Phone:408-516-6261
Mailing Address - Fax:
Practice Address - Street 1:1530 MERIDIAN AVE
Practice Address - Street 2:SUITE 150
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95125-5350
Practice Address - Country:US
Practice Address - Phone:408-264-3000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-23
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10119225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist