Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207SG0201X | Clinical Genetics (M.D.) | G76310 | CA |
NPI | 1861566465 |
---|---|
Provider Name | Joann Bergoffen |
First Address | Oakland, CA 94612-3429 |
Second Address | San Jose, CA 95119-1130 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G763100 | (05) | CA |
F70622 | (02) |