Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 234013 | NY |
Y | 207VG0400X | Gynecologist | 95982 | CA |
NPI | 1184726481 |
---|---|
Provider Name | Dr. Rashida Bazolo N'gouamba |
First Address | Pasadena, CA 91105-3170 |
Second Address | Pasadena, CA 91105 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/09/2006 |
Last Update Date | 04/09/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02826319 | (05) | NY |