Provider Demographics
NPI:1801335039
Name:SULAVER, AMBER
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:SULAVER
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 1:1399 S WINCHESTER BLVD
Mailing Address - Street 2:SUITE 140
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-4300
Mailing Address - Country:US
Mailing Address - Phone:408-261-0772
Mailing Address - Fax:408-261-0766
Practice Address - Street 1:1399 S WINCHESTER BLVD
Practice Address - Street 2:SUITE 140
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-4300
Practice Address - Country:US
Practice Address - Phone:408-261-0772
Practice Address - Fax:408-261-0766
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-21
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA62837225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist