Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 95011605 | CA |
NPI | 1023524691 |
---|---|
Provider Name | Shararah Aziz |
First Address | Tracy, CA 95377-7205 |
Second Address | Tracy, CA 95377-7205 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/12/2017 |
Last Update Date | 20/05/2019 |