Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | G76784 | CA |
N | 207VG0400X | Gynecologist | G76784 | CA |
NPI | 1023151115 |
---|---|
Provider Name | Bertha Chen |
First Address | Palo Alto, CA 94303-3341 |
Second Address | Stanford, CA 94305-2200 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/02/2007 |
Last Update Date | 20/09/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G11830 | (02) | CA |