Individual
ASTA IAH BAISA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN, PHN, FNP-C
Contact information
Practice address
2455 SAN RAMON VALLEY BLVD, SAN RAMON, CA 94583-1601
(866) 389-2727
Mailing address
2806 MARINA BLVD APT 4, SAN LEANDRO, CA 94577-4048
(510) 967-6703
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
95086184
CA
363LF0000X
Family Nurse Practitioner
Primary
95008367
CA
Other
Enumeration date
09/28/2018
Last updated
10/24/2018
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