Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2080P0205X | Pediatric Endocrinologist | 82212 | MA |
Y | 2080P0205X | Pediatric Endocrinologist | G77674 | CA |
NPI | 1225059553 |
---|---|
Provider Name | Dr. Diane Elizabeth Jackson Stafford |
First Address | Palo Alto, CA 94304-1601 |
Second Address | Palo Alto, CA 94304-1601 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2006 |
Last Update Date | 30/10/2018 |