Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | A69278 | CA |
N | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | A69278 | CA |
NPI | 1174665756 |
---|---|
Provider Name | Dr. Vijaya Bansal |
First Address | Lodi, CA 95241-1090 |
Second Address | Stockton, CA 95204 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/02/2007 |
Last Update Date | 15/04/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F90307 | (02) | CA |