Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | G64847 | CA |
NPI | 1013082072 |
---|---|
Provider Name | Beth F Green |
First Address | Los Gatos, CA 95030-7211 |
Second Address | Los Gatos, CA 95030-7211 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/11/2006 |
Last Update Date | 10/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E89830 | (02) |