Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0120X | Pediatric Surgery | A109860 | CA |
NPI | 1013101500 |
---|---|
Provider Name | Dr. Rebecca Anne Stark |
First Address | Sacramento, CA 95817-1418 |
Second Address | Sacramento, CA 95817-2207 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/08/2007 |
Last Update Date | 20/07/2016 |