Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156F00000X | Technician/Technologist | CPT02020090 | CA |
NPI | 1144843855 |
---|---|
Provider Name | Elizabeth Rogers |
First Address | Sacramento, CA 95835-1845 |
Second Address | Roseville, CA 95661-3850 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/05/2020 |
Last Update Date | 11/06/2020 |