Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 29806 | CA |
NPI | 1003938242 |
---|---|
Provider Name | Dr. Marilyn B Jespersen |
First Address | Cupertino, CA 95014-3025 |
Second Address | Cupertino, CA 95014-3025 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2007 |
Last Update Date | 08/07/2007 |