Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | G58411 | CA |
NPI | 1033293006 |
---|---|
Provider Name | Maurice D. Kinsolving |
First Address | Oakland, CA 94612-3466 |
Second Address | San Rafael, CA 94903-3308 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2006 |
Last Update Date | 30/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G584110 | (05) | CA |
F20290 | (02) |