Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | G37222 | CA |
NPI | 1083674709 |
---|---|
Provider Name | Mary B Sherman |
First Address | Seal Beach, CA 90740-1685 |
Second Address | Seal Beach, CA 90740-4907 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/03/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F11955 | (02) | CA |