Provider Demographics
NPI:1811633753
Name:DEL REAL, MAYRA MUNOZ (DROT)
Entity type:Individual
Prefix:
First Name:MAYRA
Middle Name:MUNOZ
Last Name:DEL REAL
Suffix:
Gender:F
Credentials:DROT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 LESTER AVE APT 5
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95125-3148
Mailing Address - Country:US
Mailing Address - Phone:408-775-5728
Mailing Address - Fax:
Practice Address - Street 1:350 TWIN DOLPHIN DR STE 123
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94065-1458
Practice Address - Country:US
Practice Address - Phone:650-259-8500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-11
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist