Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175L00000X | Homeopath |
NPI | 1174726764 |
---|---|
Provider Name | Brenda Marie Siegfried |
First Address | Modesto, CA 95350-5240 |
Second Address | Modesto, CA 95350-4062 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2007 |
Last Update Date | 08/07/2007 |