Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | G81439 | CA |
N | 207NS0135X | Procedural Dermatology | G81439 | CA |
NPI | 1518911395 |
---|---|
Provider Name | Serena Mraz |
First Address | Vallejo, CA 94590-2929 |
Second Address | Vallejo, CA 94590-2929 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2006 |
Last Update Date | 10/03/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G64525 | (02) | CA |
GR0023150 | (05) | CA |