Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | PT13315 | CA |
NPI | 1881759736 |
---|---|
Provider Name | Stephanie Mccaffrey |
First Address | Larkspur, CA 94939-1143 |
Second Address | Larkspur, CA 94939-1143 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/12/2006 |
Last Update Date | 08/07/2007 |