Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | A143950 | CA |
Y | 207QS0010X | Family Doctor - Sports Medicine | A143950 | CA |
NPI | 1164805354 |
---|---|
Provider Name | Amity Clow |
First Address | San Diego, CA 92127-1603 |
Second Address | San Diego, CA 92127 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2015 |
Last Update Date | 12/09/2019 |