Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0000X | Obstetrician | A77518 | CA |
NPI | 1215952056 |
---|---|
Provider Name | Miel Marie Vallejo-Brooks |
First Address | San Jose, CA 95150-5280 |
Second Address | San Jose, CA 95128-2604 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2006 |
Last Update Date | 21/01/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A775180 | (05) | CA |
I07664 | (02) | CA |