Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | G79065 | CA |
NPI | 1013042266 |
---|---|
Provider Name | Dr. Ella Faktorovich |
First Address | San Francisco, CA 94109-5455 |
Second Address | San Francisco, CA 94109-5455 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/02/2007 |
Last Update Date | 08/07/2007 |