Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | A72155 | CA |
NPI | 1013948751 |
---|---|
Provider Name | Jill Louise Ostrem |
First Address | San Francisco, CA 94143-0348 |
Second Address | San Francisco, CA 94143-0348 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2006 |
Last Update Date | 06/09/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A721550 | (05) | CA |
H86834 | (02) | CA |