Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | 95007316 | CA |
NPI | 1003323320 |
---|---|
Provider Name | Sarah Jane Mogel |
First Address | Glendale, CA 91206-4755 |
Second Address | Inglewood, CA 90301-4011 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/01/2018 |
Last Update Date | 09/01/2018 |