Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | A113697 | CA |
NPI | 1003045683 |
---|---|
Provider Name | Dr. Kali Rose Tileston |
First Address | Woodside, CA 94062-3520 |
Second Address | Woodside, CA 94062-3520 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2009 |
Last Update Date | 15/07/2014 |