Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2080P0202X | Pediatric Cardiologist | G69209 | CA |
Y | 208G00000X | Cardiothoracic Vascular Surgeon | G69209 | CA |
NPI | 1013934702 |
---|---|
Provider Name | Dr. Richard D Mainwaring |
First Address | Palo Alto, CA 94304-1601 |
Second Address | Palo Alto, CA 94304-1601 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2006 |
Last Update Date | 28/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G692090 | (05) | CA |
E47664 | (02) | CA |