Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | G79171 | CA |
Y | 207VE0102X | Reproductive Endocrinologist | G79171 | CA |
NPI | 1497843742 |
---|---|
Provider Name | Salli Tazuke |
First Address | Mountain View, CA 94040-6203 |
Second Address | Palo Alto, CA 94301-2302 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2006 |
Last Update Date | 21/04/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F96872 | (02) | CA |