Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | A143766 | CA |
NPI | 1003201237 |
---|---|
Provider Name | Jayme Congdon |
First Address | San Francisco, CA 94118-6210 |
Second Address | San Francisco, CA 94158 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2015 |
Last Update Date | 11/01/2019 |