Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | 295004 | CA |
Y | 213ES0000X | Sports Medicine | 295004 | CA |
NPI | 1487115556 |
---|---|
Provider Name | Tiara Dunson |
First Address | San Francisco, CA 94103-3946 |
Second Address | San Francisco, CA 94103-3946 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2019 |
Last Update Date | 29/03/2019 |