Provider Demographics
NPI:1972118586
Name:OLIVEIRA RIBEIRO DE SA, NIANE
Entity type:Individual
Prefix:
First Name:NIANE
Middle Name:
Last Name:OLIVEIRA RIBEIRO DE SA
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 1:1052 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94301-2424
Mailing Address - Country:US
Mailing Address - Phone:650-564-2429
Mailing Address - Fax:
Practice Address - Street 1:1174 LINCOLN AVE STE 5
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95125-3029
Practice Address - Country:US
Practice Address - Phone:650-503-4737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-10
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA74725225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty