Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | A135968 | CA |
NPI | 1316174352 |
---|---|
Provider Name | Jewmaull Josiah Reed |
First Address | Santa Rosa, CA 95401-4120 |
Second Address | Ukiah, CA 95482-4568 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2009 |
Last Update Date | 15/02/2017 |