Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 34136 | CA |
NPI | 1346715174 |
---|---|
Provider Name | Dr. Kaci Madden |
First Address | San Diego, CA 92121-1739 |
Second Address | San Diego, CA 92121-1739 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/10/2018 |
Last Update Date | 08/10/2018 |