Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 639386 | CA |
NPI | 1003185992 |
---|---|
Provider Name | Natalya Malyuga |
First Address | San Francisco, CA 94110-4697 |
Second Address | San Francisco, CA 94110-4697 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/12/2011 |
Last Update Date | 08/04/2015 |