Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | A137549 | CA |
N | 207QA0505X | Family Doctor - Adult Medicine | A137549 | CA |
NPI | 1194067215 |
---|---|
Provider Name | Dr. Mamie Sarpoma Sefa Boakye |
First Address | Oceanside, CA 92051-7024 |
Second Address | Vista, CA 92084-5218 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2013 |
Last Update Date | 22/07/2020 |