Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | G87720 | CA |
Y | 2080P0201X | Pediatric Allergist | G87720 | CA |
NPI | 1871525378 |
---|---|
Provider Name | Dr. Jennifer M. Puck |
First Address | San Francisco, CA 94143 |
Second Address | San Francisco, CA 94158 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2006 |
Last Update Date | 05/06/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G877200 | (05) | CA |