Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | G80370 | CA |
N | 208600000X | Surgeon | G80370 | CA |
Y | 2086S0102X | Surgical Critical Care | G80370 | CA |
N | 2086S0127X | Trauma Surgeon | G80370 | CA |
NPI | 1518077460 |
---|---|
Provider Name | Krista Leanna Kaups |
First Address | Fresno, CA 93721-1431 |
Second Address | Fresno, CA 93721-1324 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 14/01/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G803700 | (05) | CA |
E54061 | (02) | CA |