Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | A95639 | CA |
Y | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | A95639 | CA |
NPI | 1639353279 |
---|---|
Provider Name | Dr. Sujatha Pathi |
First Address | Greenbrae, CA 94904 |
Second Address | Greenbrae, CA 94904-3119 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/12/2007 |
Last Update Date | 24/08/2020 |