Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | A54533 | CA |
NPI | 1265496301 |
---|---|
Provider Name | Dr. Juan Esteban Posada |
First Address | San Jose, CA 95116-1925 |
Second Address | San Jose, CA 95116-1925 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2006 |
Last Update Date | 24/09/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1851590780 | RENDERING NPI (01) | CA |
A54533 | STATE LINCENSE (01) | CA |
G45811 | (02) | CA |