Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | A60035 | CA |
NPI | 1053447532 |
---|---|
Provider Name | Griffeth Tully |
First Address | Los Altos, CA 94022-1408 |
Second Address | Mountain View, CA 94040-2833 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/02/2007 |
Last Update Date | 18/02/2020 |