Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 157275 | CA |
NPI | 1154807477 |
---|---|
Provider Name | Dr. Elisabeth Martin |
First Address | Palo Alto, CA 94304-1601 |
Second Address | Palo Alto, CA 94304 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2018 |
Last Update Date | 13/05/2020 |