Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223P0221X | Pediatric Dentist | 22285 | TX |
Y | 1223P0221X | Pediatric Dentist | 53480 | CA |
NPI | 1023239456 |
---|---|
Provider Name | Dr. Jamie Jad Sahouria |
First Address | Rohnert Park, CA 94928-2902 |
Second Address | Rohnert Park, CA 94928-2902 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2007 |
Last Update Date | 25/11/2008 |