Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC1500X | Nurse Practitioner - Community Health | NP13851 | CA |
NPI | 1598986192 |
---|---|
Provider Name | Lily Pe Khoshaba |
First Address | Winton, CA 95388-9532 |
Second Address | Winton, CA 95388-9532 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2007 |
Last Update Date | 07/10/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
NP13851 | NURSE PRACTIONER (01) | CA |