Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 28053 | KS |
NPI | 1063518546 |
---|---|
Provider Name | Celina C Bernabe |
First Address | Overland Park, KS 66211-1375 |
Second Address | Overland Park, KS 66211-1375 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2006 |
Last Update Date | 25/09/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H32701 | (02) | KS |