Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 230724 | CA |
NPI | 1043422884 |
---|---|
Provider Name | Ms. Donna J King |
First Address | San Diego, CA 92123 |
Second Address | San Diego, CA 92111 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2007 |
Last Update Date | 08/07/2007 |