Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | 383997 | CA |
NPI | 1003213679 |
---|---|
Provider Name | Jodie Sugiyama |
First Address | San Jose, CA 95124-5156 |
Second Address | San Jose, CA 95124-5156 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/11/2014 |
Last Update Date | 26/11/2014 |