Provider Demographics
NPI:1184913253
Name:TOTAH, JOANN
Entity type:Individual
Prefix:
First Name:JOANN
Middle Name:
Last Name:TOTAH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1520 PARKMOOR AVE STE A
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-2422
Mailing Address - Country:US
Mailing Address - Phone:408-241-9911
Mailing Address - Fax:408-241-7788
Practice Address - Street 1:1520 PARKMOOR AVE STE A
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-2422
Practice Address - Country:US
Practice Address - Phone:408-241-9911
Practice Address - Fax:408-241-7788
Is Sole Proprietor?:No
Enumeration Date:2011-03-29
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-11-7951103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst