Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 20A14335 | CA |
NPI | 1003229352 |
---|---|
Provider Name | Terry Chen |
First Address | Santa Maria, CA 93454-5906 |
Second Address | Pismo Beach, CA 93449-4976 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2014 |
Last Update Date | 12/09/2017 |