Provider Demographics
NPI:1982676151
Name:DE JUAN, JOSE AMER SE (OTR/L,OTD(C))
Entity Type:Individual
Prefix:MR
First Name:JOSE AMER
Middle Name:SE
Last Name:DE JUAN
Suffix:
Gender:M
Credentials:OTR/L,OTD(C)
Other - Prefix:MR
Other - First Name:AMER
Other - Middle Name:SE
Other - Last Name:DE JUAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR/L,OTD(C)
Mailing Address - Street 1:4 EUCALYPTUS AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94080-2452
Mailing Address - Country:US
Mailing Address - Phone:832-472-2177
Mailing Address - Fax:
Practice Address - Street 1:4 EUCALYPTUS AVE
Practice Address - Street 2:
Practice Address - City:SOUTH SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94080-2452
Practice Address - Country:US
Practice Address - Phone:832-472-2177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-02
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4425225X00000X, 225XH1200X, 225XN1300X, 225XE1200X, 225XG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitation
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
No225XE1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistErgonomics
No225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA562OtherNEURO-IFRAH CERTIFIED
CA985705OtherNBCOT-OTR/L
CA4425OtherCALIFORNIA BOARD OF OT