Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | 025103DE00008237 | WA |
NPI | 1033180047 |
---|---|
Provider Name | Gretchen Folk |
First Address | San Diego, CA 92134-1098 |
Second Address | San Diego, CA 92134-1098 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/01/2006 |
Last Update Date | 08/07/2007 |