Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | E5574 | CA |
Y | 222Z00000X | Podiatrist | E5574 | CA |
NPI | 1033590211 |
---|---|
Provider Name | Jessica Amano |
First Address | Santa Clara, CA 95051-5173 |
Second Address | Santa Clara, CA 95051-5173 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2015 |
Last Update Date | 03/09/2019 |