Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | A122988 | CA |
Y | 111NI0900X | Internist | A122988 | CA |
N | 207RA0401X | Internist - Addiction Medicine | A122988 | CA |
NPI | 1780021766 |
---|---|
Provider Name | Dr. Ingeborg Schafhalter-Zoppoth |
First Address | Mountain View, CA 94040-6203 |
Second Address | San Francisco, CA 94118-1662 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/05/2013 |
Last Update Date | 25/02/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A122988 | STATE MEDICAL LICENSE (01) | CA |
FS3572105 | FEDERAL DEA LICENSE (01) | CA |