Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | A55632 | CA |
Y | 111NI0900X | Internist | A55632 | CA |
N | 207RE0101X | Endocrinologist (Diabetes Doctor) | A55632 | CA |
NPI | 1063582948 |
---|---|
Provider Name | Dr. Mariam Robert Manoukian |
First Address | Mountain View, CA 94040-4106 |
Second Address | Mountain View, CA 94040-4106 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/11/2006 |
Last Update Date | 14/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G85843 | (02) | CA |