Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | A41126 | CA |
N | 111NI0900X | Internist | A41126 | CA |
Y | 207RG0300X | Geriatric Medicine | A41126 | CA |
NPI | 1033104724 |
---|---|
Provider Name | Radha Menon |
First Address | Apple Valley, CA 92307-2125 |
Second Address | Apple Valley, CA 92307-2194 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/09/2005 |
Last Update Date | 23/02/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A411260 | (05) | CA |
A29309 | (02) | CA |