Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | A62475 | CA |
NPI | 1003968801 |
---|---|
Provider Name | Vajiramala R. Dharmasena |
First Address | Oakland, CA 94612-3466 |
Second Address | San Jose, CA 95119-1130 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/01/2007 |
Last Update Date | 06/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A624750 | (05) | CA |
H00408 | (02) |