Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208100000X | Physical Medicine & Rehabilitation Doctor | G74906 | CA |
N | 2081S0010X | Sports Medicine | G74906 | CA |
N | 213ES0000X | Sports Medicine | G74906 | CA |
NPI | 1528093101 |
---|---|
Provider Name | Allen Kaisler-Meza |
First Address | San Jose, CA 95125-5109 |
Second Address | San Jose, CA 95125-5109 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F52234 | (02) | CA |