Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | A118532 | CA |
Y | 207YP0228X | Pediatric Otolaryngology | A118532 | CA |
NPI | 1952612905 |
---|---|
Provider Name | Jamie Lauren Funamura |
First Address | Sacramento, CA 95817-2207 |
Second Address | Sacramento, CA 95817-2207 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2010 |
Last Update Date | 04/01/2017 |