Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 20A18805 | CA |
N | 207VG0400X | Gynecologist | 20A18805 | CA |
N | 207VX0000X | Obstetrician | 20A18805 | CA |
NPI | 1164961439 |
---|---|
Provider Name | Priya Panneerselvam |
First Address | Fresno, CA 93721-1431 |
Second Address | Fresno, CA 93721-1324 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/02/2017 |
Last Update Date | 01/07/2021 |