Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 170100000X | Medical Geneticist |
NPI | 1124496690 |
---|---|
Provider Name | Renz Lorenz Gatchalian |
First Address | Hayward, CA 94545-4158 |
Second Address | Hayward, CA 94545-4158 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/09/2015 |
Last Update Date | 14/09/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
90718960F02067 | MEDI CAL (01) | CA |
91773198E15141 | MEDI CAL (01) | CA |
95873198E89104 | MEDI CAL (01) | CA |