Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 20A8069 | CA |
NPI | 1639330541 |
---|---|
Provider Name | Susan C Cislo |
First Address | Napa, CA 94558-2414 |
Second Address | Napa, CA 94558-2414 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2008 |
Last Update Date | 23/06/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
20A8069 | CA LICENSE (01) | CA |