Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0401X | Internist - Addiction Medicine | G54733 | CA |
NPI | 1679593693 |
---|---|
Provider Name | Diana Amodia |
First Address | Sacramento, CA 95865-4947 |
Second Address | San Francisco, CA 94102-3329 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2006 |
Last Update Date | 15/03/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G547330 | BLUE SHIELD (01) | CA |
E80898 | (02) | CA |