Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 17362 | CA |
NPI | 1770786030 |
---|---|
Provider Name | Dr. Kimberly Ruth Gordacan |
First Address | Santa Rosa, CA 95403-3402 |
Second Address | Santa Rosa, CA 95403-3402 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2007 |
Last Update Date | 08/07/2007 |