Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 95010870 | CA |
NPI | 1053879932 |
---|---|
Provider Name | Anitha Choorakulam George |
First Address | Sacramento, CA 95827-2539 |
Second Address | Modesto, CA 95355-4201 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/03/2019 |
Last Update Date | 10/04/2019 |