Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207U00000X | Nuclear Medicine Specialist | A115371 | CA |
NPI | 1659535102 |
---|---|
Provider Name | Nataraj Shanmugam |
First Address | Rancho Cordova, CA 95670-7956 |
Second Address | Sacramento, CA 95816-7058 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2008 |
Last Update Date | 11/02/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
524526 | (05) | AZ |
A115371 | MEDICAL LICENSE (01) | CA |
Z137927 | MEDICARE PTAN FOR MDIG-YUMA (01) | AZ |