Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | E4324 | CA |
Y | 222Z00000X | Podiatrist | E4324 | CA |
NPI | 1043389406 |
---|---|
Provider Name | Mary Prince |
First Address | San Leandro, CA 94577-4201 |
Second Address | San Leandro, CA 94577-4201 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/11/2006 |
Last Update Date | 14/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
V02429 | (02) | CA |