Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | I11479 | CA |
NPI | 1023192960 |
---|---|
Provider Name | Robin Lee Zagone |
First Address | Eureka, CA 95501-3345 |
Second Address | Eureka, CA 95501-3345 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2006 |
Last Update Date | 11/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A87575 | STATE LISCENCE (01) | CA |
I11479 | (02) | CA |