Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 60102 | MN |
N | 207RG0300X | Geriatric Medicine | 40773 | CO |
N | 207RG0300X | Geriatric Medicine | 60102 | MN |
NPI | 1023021409 |
---|---|
Provider Name | Dr. Clemencia Rasquinha |
First Address | Golden Valley, MN 55422-4544 |
Second Address | Golden Valley, MN 55422-4544 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2006 |
Last Update Date | 10/12/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
56229216 | (05) | CO |