Provider Demographics
NPI:1396121729
Name:KONRAD, EDMOND GEORGE II
Entity type:Individual
Prefix:MR
First Name:EDMOND
Middle Name:GEORGE
Last Name:KONRAD
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 CALDERON AVE APT 402
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94041-1460
Mailing Address - Country:US
Mailing Address - Phone:813-516-7997
Mailing Address - Fax:
Practice Address - Street 1:151 CALDERON AVE APT 402
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94041-1460
Practice Address - Country:US
Practice Address - Phone:813-516-7997
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-07
Last Update Date:2015-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOTA 3122224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant