Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | RN412943 | CA |
NPI | 1093817645 |
---|---|
Provider Name | Mrs. Marion C Colombo |
First Address | Santa Clara, CA 95051 |
Second Address | Santa Clara, CA 95051-5329 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
P17585 | (02) | CA |