Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 95009791 | CA |
NPI | 1023583580 |
---|---|
Provider Name | Zachary Sebastian Teixeira |
First Address | Fremont, CA 94536-5018 |
Second Address | Fremont, CA 94536-4917 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/10/2018 |
Last Update Date | 10/10/2018 |