Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | NP95008421 | CA |
NPI | 1063903201 |
---|---|
Provider Name | Nisha Ann Roy |
First Address | Modesto, CA 95355-2708 |
Second Address | Modesto, CA 95355-2708 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2018 |
Last Update Date | 23/05/2018 |