Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 71002965 | IN |
NPI | 1083776512 |
---|---|
Provider Name | Ms. Rekha George |
First Address | San Ramon, CA 94583-4750 |
Second Address | San Ramon, CA 94583-4750 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/12/2006 |
Last Update Date | 20/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200949210 | (05) | IN |