Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LP0200X | Nurse Practitioner - Pediatrics | 382437 | NY |
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 95000794 | CA |
NPI | 1033559307 |
---|---|
Provider Name | Carmen Aguilar Mandac |
First Address | Palo Alto, CA 94304-1511 |
Second Address | Palo Alto, CA 94304-1511 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2013 |
Last Update Date | 23/09/2015 |