Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | A141509 | CA |
N | 208600000X | Surgeon | A141509 | CA |
Y | 2086X0206X | Surgical Oncologist | A141509 | CA |
NPI | 1265851182 |
---|---|
Provider Name | Dr. Joanne Krissy Edquilang |
First Address | Los Altos, CA 94022-1408 |
Second Address | San Francisco, CA 94115-1931 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/04/2014 |
Last Update Date | 03/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A141509 | STATE MEDICAL LICENSE (01) | CA |