Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 24755 | CA |
NPI | 1497836068 |
---|---|
Provider Name | Dr. Paul James Quarneri |
First Address | San Mateo, CA 94402-3117 |
Second Address | San Mateo, CA 94402-3116 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/10/2006 |
Last Update Date | 25/06/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
DC0247550 | BLUE CROSS/BLUE SHIELD (01) | CA |