Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | G65893 | CA |
NPI | 1033281795 |
---|---|
Provider Name | Jacqueline N. Pelavin |
First Address | Oakland, CA 94612-3429 |
Second Address | Santa Clara, CA 95051-5173 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G658930 | (05) | CA |
F11114 | (02) |