Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | A77924 | CA |
NPI | 1033297932 |
---|---|
Provider Name | Sun D. Hansrote |
First Address | Oakland, CA 94612-3429 |
Second Address | Manteca, CA 95337-5130 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A779240 | (05) | CA |
H35049 | (02) |