Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | A125601 | CA |
NPI | 1013123140 |
---|---|
Provider Name | Dr. Cynthia M. Mullen |
First Address | Walnut Creek, CA 94598-2512 |
Second Address | Walnut Creek, CA 94598-2512 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2007 |
Last Update Date | 06/12/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A125601 | MEDICAL LICENSE (01) |