Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | A41759 | CA |
NPI | 1154428621 |
---|---|
Provider Name | Garfield Cameron Pickell |
First Address | Modesto, CA 95356-9259 |
Second Address | Modesto, CA 95356-9259 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/09/2006 |
Last Update Date | 11/02/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
AB1755517 | DEA NUMBER (01) | CA |
HPC01543F | (05) | CA |