Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | 549882 | CA |
NPI | 1023391216 |
---|---|
Provider Name | Mrs. Joli Vavao |
First Address | Stanford, CA 94305-5327 |
Second Address | Stanford, CA 94305-2200 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/09/2011 |
Last Update Date | 27/09/2011 |