Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | A23162 | CA |
NPI | 1033177449 |
---|---|
Provider Name | Dr. Kathleen L Long |
First Address | San Luis Obispo, CA 93401-3600 |
Second Address | San Luis Obispo, CA 93401-3600 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2006 |
Last Update Date | 14/03/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A23413 | (02) | CA |