Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | 16156 | CA |
NPI | 1043500358 |
---|---|
Provider Name | Rebecca Jahromi |
First Address | San Jose, CA 95124-2528 |
Second Address | Palo Alto, CA 94304 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/04/2011 |
Last Update Date | 15/11/2016 |