Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | G45508 | CA |
NPI | 1013030840 |
---|---|
Provider Name | Angela Marie Condie |
First Address | Saratoga, CA 95070-3519 |
Second Address | Saratoga, CA 95070-3519 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/04/2007 |
Last Update Date | 08/07/2007 |