Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | A158169 | CA |
N | 2080P0201X | Pediatric Allergist | 245775 | MA |
NPI | 1235391640 |
---|---|
Provider Name | Dr. Mudita Gogna |
First Address | Sacramento, CA 95815-4314 |
Second Address | Roseville, CA 95661-3047 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2008 |
Last Update Date | 14/05/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
110088231A | (05) | MA |