Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | A86547 | CA |
Y | 207ND0101X | MOHS-Micrographic Surgeon | A86547 | CA |
NPI | 1093960643 |
---|---|
Provider Name | Aleda A. Longwell |
First Address | Danville, CA 94526-3320 |
Second Address | Danville, CA 94526-6258 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/11/2008 |
Last Update Date | 30/04/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
BJ276Z | MEDICARE PTAN (01) | CA |
CB368 | MEDICARE PTAN (01) | CA |