Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223D0004X | Dentist Anesthesiologist | 8003962210 | CA |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 95010112 | CA |
NPI | 1447732409 |
---|---|
Provider Name | Mary Alvarez-Nutting |
First Address | Oakland, CA 94619-2006 |
Second Address | San Jose, CA 95126-1733 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/09/2018 |
Last Update Date | 08/07/2019 |