Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | G50246 | CA |
NPI | 1093726663 |
---|---|
Provider Name | Sylvia J Shaw |
First Address | Lynwood, CA 90262 |
Second Address | Lynwood, CA 90262-3512 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2006 |
Last Update Date | 25/09/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G502461 | (05) | CA |
E79778 | (02) |