Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | A90070 | CA |
NPI | 1346382314 |
---|---|
Provider Name | Justin Collingham |
First Address | Walnut Creek, CA 94596-9001 |
Second Address | Walnut Creek, CA 94596-4180 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/02/2007 |
Last Update Date | 15/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A900700 | (05) | CA |
I34078 | (02) | CA |