Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207U00000X | Nuclear Medicine Specialist | A42996 | CA |
NPI | 1710090527 |
---|---|
Provider Name | Mrs. Manju P Gan |
First Address | Granada Hills, CA 91344-1093 |
Second Address | Sylmar, CA 91342-1437 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G96317 | (02) |