Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RN0300X | Nephrologist | A71615 | CA |
NPI | 1043374879 |
---|---|
Provider Name | Christine Ives |
First Address | Ukiah, CA 95482-5016 |
Second Address | Ukiah, CA 95482-5016 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/12/2006 |
Last Update Date | 01/08/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A716150 | (05) | CA |
H16622 | (02) |