Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2080P0207X | Pediatric Hematology-Oncologist | 95011513 | CA |
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 95011513 | CA |
NPI | 1043873557 |
---|---|
Provider Name | Lea Shangraw Fox |
First Address | Alameda, CA 94501-1704 |
Second Address | Oakland, CA 94609-1809 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2019 |
Last Update Date | 21/06/2019 |