Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 51603 | CA |
NPI | 1154589935 |
---|---|
Provider Name | Dr. Diana Swanson |
First Address | San Jose, CA 95124-3038 |
Second Address | San Jose, CA 95124-3038 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/05/2008 |
Last Update Date | 28/05/2008 |