Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | G85670 | CA |
NPI | 1033491873 |
---|---|
Provider Name | Deirdre Alexander |
First Address | San Francisco, CA 94118-1636 |
Second Address | San Francisco, CA 94118-1636 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/09/2011 |
Last Update Date | 19/09/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G62049 | (02) | NY |