Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 20092 | CA |
NPI | 1043557796 |
---|---|
Provider Name | Janelle Facchino |
First Address | San Francisco, CA 94143-2204 |
Second Address | San Francisco, CA 94143-2204 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/01/2013 |
Last Update Date | 14/01/2013 |