Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 13776 | CA |
NPI | 1013136142 |
---|---|
Provider Name | Zenaida J Pablo |
First Address | Elk Grove, CA 95758-5800 |
Second Address | Elk Grove, CA 95758-7449 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2007 |
Last Update Date | 08/07/2007 |