Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0205X | Pediatric Endocrinologist | A055142 | CA |
NPI | 1194739540 |
---|---|
Provider Name | Jennifer Ann Olson |
First Address | Oakland, CA 94609-1809 |
Second Address | Oakland, CA 94609-1809 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A551420 | (05) | CA |
H17274 | (02) |