Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | A138658 | CA |
Y | 207QG0300X | Family Doctor - Geriatric Medicine | A138658 | CA |
NPI | 1093126856 |
---|---|
Provider Name | Dr. Leah Beth Rorvig |
First Address | Petaluma, CA 94954-6559 |
Second Address | Petaluma, CA 94954-6559 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/05/2014 |
Last Update Date | 02/11/2021 |