Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2251E1300X | Electrophysiology, Clinical | EK 24 | CA |
Y | 2251P0200X | Physical Therapist - Pediatrics | PT 9593 | CA |
NPI | 1083634588 |
---|---|
Provider Name | Mrs. Janet Stark Buttermore |
First Address | San Diego, CA 92131-1918 |
Second Address | San Diego, CA 92128-2439 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2006 |
Last Update Date | 11/01/2016 |