Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TH0100X | Health Service |
NPI | 1093349938 |
---|---|
Provider Name | Paul Warren Eastman |
First Address | Berkeley, CA 94720-4304 |
Second Address | Berkeley, CA 94720-4304 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/03/2020 |
Last Update Date | 01/03/2020 |