Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156F00000X | Technician/Technologist | TCH3006 | CA |
NPI | 1013548015 |
---|---|
Provider Name | Nancy Afholderbach |
First Address | Pittsburg, CA 94565-1916 |
Second Address | Pittsburg, CA 94565-1916 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/01/2020 |
Last Update Date | 28/01/2020 |