Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0203X | Pediatric Critical Care Doctor | G86346 | CA |
NPI | 1114977873 |
---|---|
Provider Name | Dr. Robert Keith Pretzlaff |
First Address | Sacramento, CA 95817-2208 |
Second Address | Sacramento, CA 95817-2208 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H06652 | (02) | CA |