Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0202X | Pediatric Cardiologist | C32992 | CA |
NPI | 1083723852 |
---|---|
Provider Name | Dr. James Vincent Prochazka |
First Address | Fresno, CA 93711-0218 |
Second Address | Madera, CA 93638-8761 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A35130 | (02) | CA |
C329992 | STATE MEDICAL LICENSE (01) | CA |