Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | DC29484 | CA |
NPI | 1083731871 |
---|---|
Provider Name | Dr. Nicolas Vallejos |
First Address | Sausalito, CA 94965-2104 |
Second Address | Sausalito, CA 94965-1973 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/03/2007 |
Last Update Date | 17/03/2018 |