Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | A50689 | CA |
NPI | 1003994617 |
---|---|
Provider Name | Mauricio Garzona |
First Address | Oakland, CA 94612-3429 |
Second Address | San Francisco, CA 94115-3357 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A506890 | (05) | CA |
F43182 | (02) |