Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | G19585 | CA |
NPI | 1023239191 |
---|---|
Provider Name | Dr. Helena Joann Vipond |
First Address | Smith River, CA 95567 |
Second Address | Smith River, CA 95567 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2007 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
9304725 | (05) | CA |
A40694 | (02) | CA |