Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251H1200X | Hand | PT10142 | CA |
NPI | 1871667022 |
---|---|
Provider Name | Ms. Brenda Deidrick |
First Address | Roseville, CA 95661-3027 |
Second Address | Roseville, CA 95661-3027 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/11/2006 |
Last Update Date | 08/07/2007 |