Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | DCO19610 | CA |
NPI | 1124206321 |
---|---|
Provider Name | Dr. Josephine Smith |
First Address | Santa Rosa, CA 95404-3907 |
Second Address | Santa Rosa, CA 95404-3907 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/02/2008 |
Last Update Date | 22/01/2016 |