Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207SG0201X | Clinical Genetics (M.D.) | 37842 | AZ |
Y | 208000000X | Pediatrician | 37842 | AZ |
NPI | 1073791992 |
---|---|
Provider Name | Jacqueline Siegel-Bartelt |
First Address | Santa Monica, CA 90405-4557 |
Second Address | Phoenix, AZ 85013-4405 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/02/2008 |
Last Update Date | 01/02/2008 |