Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 151496 | CA |
NPI | 1033563689 |
---|---|
Provider Name | Margaret Mariella |
First Address | Bakersfield, CA 93306-4018 |
Second Address | Danville, CA 94526 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2016 |
Last Update Date | 24/05/2021 |