Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0205X | Pediatric Endocrinologist | A62688 | CA |
NPI | 1083702807 |
---|---|
Provider Name | Jody S Krantz |
First Address | Orange, CA 92868-3835 |
Second Address | Orange, CA 92868-3835 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/10/2006 |
Last Update Date | 30/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A626880 | (05) | CA |
H77959 | (02) | CA |