Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 8904 | CA |
NPI | 1255689766 |
---|---|
Provider Name | Dr. Rose Marie Pack |
First Address | Palm Desert, CA 92211-6032 |
Second Address | Palm Desert, CA 92211-6249 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2012 |
Last Update Date | 15/08/2012 |