Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | 7990 | CA |
NPI | 1568129286 |
---|---|
Provider Name | Miss Dianne Rust |
First Address | Los Gatos, CA 95032-4537 |
Second Address | Los Gatos, CA 95032-4537 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/11/2021 |
Last Update Date | 17/11/2021 |