Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | A79238 | CA |
Y | 213ES0000X | Sports Medicine | A79238 | CA |
NPI | 1144208885 |
---|---|
Provider Name | Brandee Lynn Waite |
First Address | Sacramento, CA 95817-2307 |
Second Address | Sacramento, CA 95817-2307 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/01/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A79238 | (05) | CA |
I17674 | (02) |