Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | A37977 | CA |
NPI | 1265664122 |
---|---|
Provider Name | Dr. Rene Marino Iway |
First Address | Roseville, CA 95661-4031 |
Second Address | Roseville, CA 95661-4031 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2009 |
Last Update Date | 11/08/2009 |