Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | A125386 | CA |
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | A125386 | CA |
NPI | 1912101668 |
---|---|
Provider Name | Jessica Cole Mcmichael |
First Address | Orange, CA 92868-3854 |
Second Address | Orange, CA 92868-3854 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2007 |
Last Update Date | 03/05/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
CB244893 | MEDICARE PTAN (01) | CA |