Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204C00000X | Sports Medicine Doctor | 73713 | CA |
Y | 225700000X | Massage Therapist | 73713 | CA |
NPI | 1114531837 |
---|---|
Provider Name | Resham Macfarlane |
First Address | Berkeley, CA 94705-2041 |
Second Address | Berkeley, CA 94705-2041 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2020 |
Last Update Date | 31/08/2020 |