Active NPI
Raymond Disalvo
- Occupational Therapist
- Greenbrae, CA
National Provider Identifier
1306209176
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 15135
- Practice address
- 1220 S Eliseo Dr
Greenbrae, CA 94904-2006 - Phone
- (415) 461-9700
- NPI assigned
- Mar 30, 2016
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 15135 | CA | Primary |
Addresses
Primary practice location
1220 S Eliseo Dr
Greenbrae, CA 94904-2006
Mailing address
130 S 23Rd St
San Jose, CA 95116-2729
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 15135 | CA | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1459296000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1459296000000",
"number": "1306209176",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "130 S 23RD ST",
"city": "SAN JOSE",
"state": "CA",
"postal_code": "951162729"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1220 S ELISEO DR",
"city": "GREENBRAE",
"state": "CA",
"postal_code": "949042006",
"telephone_number": "415-461-9700"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DISALVO",
"first_name": "RAYMOND",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-03-30",
"last_updated": "2016-03-30",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "CA",
"license": "15135",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Greenbrae, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.