Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | RN346707 | CA |
NPI | 1063662278 |
---|---|
Provider Name | Roberta Itami |
First Address | Ventura, CA 93003-3099 |
Second Address | Ventura, CA 93003-3099 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/09/2008 |
Last Update Date | 24/09/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
RN346707 | REGISTERED NURSING NUMBER (01) | CA |