Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | G69138 | CA |
NPI | 1003914516 |
---|---|
Provider Name | Dr. Mary Beth Hughes |
First Address | Los Gatos, CA 95032-3739 |
Second Address | Los Gatos, CA 95032-3739 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 15/12/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000G69138000 | (05) | CA |
F43092 | (02) |