Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | A80348 | CA |
NPI | 1003806498 |
---|---|
Provider Name | Julie Motosue-Brennan |
First Address | Sacramento, CA 95831-1949 |
Second Address | Sacramento, CA 95820-1527 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2005 |
Last Update Date | 11/02/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A803480 | (05) | CA |