Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | A150902 | CA |
NPI | 1003260811 |
---|---|
Provider Name | Myrna Mungal |
First Address | Cupertino, CA 95014-1318 |
Second Address | Palo Alto, CA 94304-1601 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2016 |
Last Update Date | 19/12/2019 |