Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | DC 24940 | CA |
NPI | 1275749871 |
---|---|
Provider Name | Dr. Carmen May Marcadis |
First Address | Middletown, CA 95461-9542 |
Second Address | Middletown, CA 95461-9542 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/05/2007 |
Last Update Date | 08/07/2007 |