Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | G47561 | CA |
N | 207VX0000X | Obstetrician | G47561 | CA |
NPI | 1003903626 |
---|---|
Provider Name | Pablo Garza Cortina |
First Address | Ukiah, CA 95482-6341 |
Second Address | Ukiah, CA 95482-6341 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2006 |
Last Update Date | 21/08/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G475613 | (05) | CA |
E02672 | (02) | CA |