Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | 30632 | CA |
NPI | 1356315469 |
---|---|
Provider Name | Sharon Michelle Crowder |
First Address | Agoura Hills, CA 91301-1688 |
Second Address | Agoura Hills, CA 91301-1688 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/02/2006 |
Last Update Date | 08/07/2007 |