Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | DC14483 | CA |
NPI | 1689729824 |
---|---|
Provider Name | Dr. Lori Susan Rodgers |
First Address | Sausalito, CA 94965-2173 |
Second Address | Sausalito, CA 94965-2173 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/01/2007 |
Last Update Date | 22/10/2010 |