Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | E-4247 | CA |
N | 222Z00000X | Podiatrist | E-4247 | CA |
Y | 213EP1101X | Primary Podiatric Medicine | E4247 | CA |
NPI | 1124182316 |
---|---|
Provider Name | Dr. Teresa Marie Van Woy |
First Address | San Pablo, CA 94806-3847 |
Second Address | San Pablo, CA 94806-3847 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/12/2006 |
Last Update Date | 29/09/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U81999 | (02) | CA |