Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207K00000X | Allergist & Immunologist | A37906 | CA |
Y | 207KA0200X | Allergist | A37906 | CA |
NPI | 1588774954 |
---|---|
Provider Name | Dr. Geeta Venkat |
First Address | Mission Viejo, CA 92691-8003 |
Second Address | Mission Viejo, CA 92691-8003 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 17/09/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E02518 | (02) | CA |