Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0214X | Pediatric Pulmonologist | G70842 | CA |
NPI | 1174541858 |
---|---|
Provider Name | Carol Conrad |
First Address | Palo Alto, CA 94304-1511 |
Second Address | Palo Alto, CA 94304 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2006 |
Last Update Date | 18/06/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G708420 | (05) | CA |
F67619 | (02) | CA |