Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NI0013X | Independent Medical Examiner | 34854 | CA |
NPI | 1518556430 |
---|---|
Provider Name | Nogol Daneshvar |
First Address | San Jose, CA 95123-4211 |
Second Address | Morgan Hill, CA 95037-3676 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/01/2021 |
Last Update Date | 14/01/2021 |