Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 44651 | CA |
Y | 213EG0000X | General Practice | 44651 | CA |
NPI | 1003025206 |
---|---|
Provider Name | Magdalena Azzarelli |
First Address | Los Gatos, CA 95032-5510 |
Second Address | San Jose, CA 95124-3242 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2007 |
Last Update Date | 08/07/2007 |