Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 20A15641 | CA |
N | 208D00000X | General Practice Physician | OS13126 | FL |
NPI | 1417298811 |
---|---|
Provider Name | Sibyl Knight |
First Address | Pacific Grove, CA 93950-7200 |
Second Address | Pacific Grove, CA 93950 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/03/2013 |
Last Update Date | 08/05/2019 |