Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | POD-000891 | AZ |
Y | 222Z00000X | Podiatrist | POD-000891 | AZ |
NPI | 1053788000 |
---|---|
Provider Name | Dr. Jessica Vernola Randolph |
First Address | Scottsdale, AZ 85254-6002 |
Second Address | Scottsdale, AZ 85254 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/08/2015 |
Last Update Date | 11/07/2018 |