Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223P0700X | Prosthodontist | 0401413018 | VA |
Y | 1223P0700X | Prosthodontist | 61883 | CA |
NPI | 1154625408 |
---|---|
Provider Name | Graciela Shimizu Oliva |
First Address | Menlo Park, CA 94025-4203 |
Second Address | Menlo Park, CA 94025-4203 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/12/2010 |
Last Update Date | 06/02/2014 |