Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | G67262 | CA |
NPI | 1013095116 |
---|---|
Provider Name | Rosetta C. Newhall |
First Address | Oakland, CA 94612-3429 |
Second Address | Antioch, CA 94509-4004 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G672620 | (05) | CA |
F15089 | (02) |