Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RN0300X | Nephrologist | A43757 | CA |
NPI | 1053418749 |
---|---|
Provider Name | Dr. Josie A Tebben |
First Address | Berkeley, CA 94705-2063 |
Second Address | Berkeley, CA 94705-2063 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/09/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A437570 | (05) | CA |
F56458 | (02) | CA |