Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | LM303 | CA |
NPI | 1053604058 |
---|---|
Provider Name | Diana Vallarta |
First Address | Los Gatos, CA 95031-2179 |
Second Address | San Jose, CA 95126 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2011 |
Last Update Date | 16/05/2014 |