Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | A104528 | CA |
NPI | 1508875642 |
---|---|
Provider Name | Stefan R Jibodh |
First Address | Walnut Creek, CA 94596-5318 |
Second Address | Walnut Creek, CA 94596-5318 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/08/2006 |
Last Update Date | 14/12/2021 |