Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NN1001X | Nutrition | 33165 | CA |
Y | 111NP0017X | Pediatric Chiropractor | 33165 | CA |
NPI | 1629460076 |
---|---|
Provider Name | Eugenie Michelle Giasson-Gomez |
First Address | Los Gatos, CA 95032-2028 |
Second Address | Los Gatos, CA 95032-2028 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/02/2015 |
Last Update Date | 23/02/2015 |