Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | G83844 | CA |
NPI | 1003994187 |
---|---|
Provider Name | Stephanie M. Po |
First Address | Oakland, CA 94612-3466 |
Second Address | Walnut Creek, CA 94598-2419 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2006 |
Last Update Date | 17/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G838440 | (05) | CA |
G68903 | (02) |