Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207SG0201X | Clinical Genetics (M.D.) | G60240 | CA |
Y | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | G60240 | CA |
N | 208000000X | Pediatrician | 387929 | CA |
NPI | 1356363154 |
---|---|
Provider Name | Denise Main |
First Address | Los Altos, CA 94022-1408 |
Second Address | San Francisco, CA 94109-6978 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2006 |
Last Update Date | 15/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A53572 | (02) | CA |