Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | A84894 | CA |
N | 111NI0900X | Internist | A84894 | CA |
N | 207RG0300X | Geriatric Medicine | A84894 | CA |
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | A84894 | CA |
NPI | 1073547824 |
---|---|
Provider Name | Dr. Tha Cha |
First Address | Fresno, CA 93710-5023 |
Second Address | Fresno, CA 93710-5023 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2006 |
Last Update Date | 29/04/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I46319 | (02) |