Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NI0013X | Independent Medical Examiner | DC27844 | CA |
NPI | 1881966075 |
---|---|
Provider Name | Dr. Andrea E Prost |
First Address | Aptos, CA 95003-3502 |
Second Address | Aptos, CA 95003-3502 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2012 |
Last Update Date | 02/02/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U90221 | (02) | CA |