Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | A156065 | CA |
Y | 2080P0216X | Pediatric Rheumatologist | A156065 | CA |
NPI | 1831585827 |
---|---|
Provider Name | Dr. Amy Claire Gaultney |
First Address | Orange, CA 92868-4203 |
Second Address | Orange, CA 92868-4203 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/04/2015 |
Last Update Date | 06/08/2021 |