Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | A92381 | CA |
N | 111NI0900X | Internist | A92381 | CA |
N | 208000000X | Pediatrician | A92381 | CA |
Y | 2080P0205X | Pediatric Endocrinologist | A92381 | CA |
NPI | 1134160666 |
---|---|
Provider Name | Renee Annette Poulin Kinman |
First Address | Fresno, CA 93721-1431 |
Second Address | Clovis, CA 93611-6886 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2006 |
Last Update Date | 29/11/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I37653 | (02) | CA |