Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | A83746 | CA |
Y | 207XS0117X | Orthopaedic Spine Surgeon | A83746 | CA |
NPI | 1114964764 |
---|---|
Provider Name | Dr. Sohrab Gollogly |
First Address | Monterey, CA 93940-5730 |
Second Address | Monterey, CA 93940-5730 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2006 |
Last Update Date | 09/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I 19354 | (02) | CA |