Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 53457 | CA |
N | 111NI0900X | Internist | 53457 | CA |
N | 207R00000X | Internist | MD00021008 | WA |
N | 111NI0900X | Internist | MD00021008 | WA |
Y | 207RH0002X | Hospice and Palliative Medicine | G53457 | CA |
N | 207RH0002X | Hospice and Palliative Medicine | MD00021008 | WA |
NPI | 1265484240 |
---|---|
Provider Name | Ms. Andrea Minor Thach |
First Address | Los Altos, CA 94022-1408 |
Second Address | Oakland, CA 94609-3412 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2006 |
Last Update Date | 09/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A52527 | (02) | CA |