Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | G65227 | CA |
NPI | 1164500930 |
---|---|
Provider Name | Merula Doris Franzgrote |
First Address | Hayward, CA 94545-4203 |
Second Address | Hayward, CA 94545-4203 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2006 |
Last Update Date | 03/08/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G652270 | (05) | CA |
F15630 | (02) |