Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 36596 | CA |
Y | 213EG0000X | General Practice | 36596 | CA |
NPI | 1003097577 |
---|---|
Provider Name | Dr. Sandra Patron |
First Address | Foster City, CA 94404-3760 |
Second Address | San Mateo, CA 94401-2585 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/11/2007 |
Last Update Date | 19/12/2008 |