Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 293354 | CA |
NPI | 1053836601 |
---|---|
Provider Name | Mrs. Anina Christine Imhof |
First Address | Santa Rosa, CA 95403-7756 |
Second Address | Santa Rosa, CA 95403-7756 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2017 |
Last Update Date | 04/08/2017 |