Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | G77444 | CA |
NPI | 1124036074 |
---|---|
Provider Name | Teresa Ann Claus |
First Address | Sherman Oaks, CA 91403 |
Second Address | Sherman Oaks, CA 91403 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2006 |
Last Update Date | 02/09/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G774440 | BLUE SHIELD (01) | |
G27973 | (02) |