Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0201X | Internist - Allergy & Immunology | G48675 | CA |
NPI | 1902812795 |
---|---|
Provider Name | Bruce Ryhal |
First Address | Roseville, CA 95678 |
Second Address | Roseville, CA 95678-5134 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A51142 | (02) | CA |