Provider Demographics
NPI:1104603323
Name:DEPAZ, MA PILAR FRANCEZKA VIOLANDA (COTA/L)
Entity type:Individual
Prefix:
First Name:MA PILAR FRANCEZKA
Middle Name:VIOLANDA
Last Name:DEPAZ
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:PILAR
Other - Middle Name:
Other - Last Name:DEPAZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:COTA/L
Mailing Address - Street 1:1000 SANDPOINT DR
Mailing Address - Street 2:
Mailing Address - City:RODEO
Mailing Address - State:CA
Mailing Address - Zip Code:94572-1933
Mailing Address - Country:US
Mailing Address - Phone:661-478-1676
Mailing Address - Fax:
Practice Address - Street 1:1058 REDWOOD HWY FRONTAGE RD
Practice Address - Street 2:
Practice Address - City:MILL VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94941-1621
Practice Address - Country:US
Practice Address - Phone:703-801-5672
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-11
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6214224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant