Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | DC015024 | CA |
N | 111NX0800X | Chiropractor Orthopedic Specialist | DC015024 | CA |
NPI | 1659466977 |
---|---|
Provider Name | Dr. Virginia St John Roe |
First Address | Oakland, CA 94609-1359 |
Second Address | Oakland, CA 94609-1359 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2006 |
Last Update Date | 02/02/2011 |