Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | 53790 | MN |
NPI | 1023217742 |
---|---|
Provider Name | Dr. Josaleen Muzquiz Davis |
First Address | Minneapolis, MN 55407-1321 |
Second Address | St Paul, MN 55114-1451 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2007 |
Last Update Date | 09/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
110014721 | (02) | MN |