Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207SG0201X | Clinical Genetics (M.D.) | G85858 | CA |
N | 208000000X | Pediatrician | G85858 | CA |
NPI | 1164434056 |
---|---|
Provider Name | Berkley Randolph Powell |
First Address | Madera, CA 93638-8761 |
Second Address | Madera, CA 93638-8761 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C94158 | (02) | CA |