NPI 1013150416

Jerad Alan Souza, PT

Practitioner Technician Eureka, CA

Practice location

Address: 720 Wood St, Eureka, CA 95501-4413
Phone: (707) 268-2990
Mailing address: 1771 Hawkes Rd, McKinleyville, CA 95519-4110

Registered specialties

Technician Primary

Nursing Service Related Providers Taxonomy 374700000X Licence PT32451 (CA)

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Registry record

NPI: 1013150416
Entity type: Individual
Sex (as registered): Male
NPI issued: 14 Apr 2009
Record last updated: 15 May 2009

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.