Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | E3764 | CA |
NPI | 1053420059 |
---|---|
Provider Name | Kathleen A Alles |
First Address | Scotts Valley, CA 95066-4035 |
Second Address | Scotts Valley, CA 95066-4035 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 22/10/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
BA0015210 | RAILROAD MEDICARE (01) | CA |
W19377 | (02) | CA |