Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0401X | Family Doctor - Addiction Medicine | G30415 | CA |
NPI | 1205859683 |
---|---|
Provider Name | Diane Lynn Hambrick |
First Address | Saint Helena, CA 94574-9554 |
Second Address | Saint Helena, CA 94574-9554 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2006 |
Last Update Date | 01/02/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A91284 | (02) | CA |