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Individual

GERALDINE M DUTRA

Active
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Individual

GERALDINE M DUTRA

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
P.A.

Taxonomy

Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA14146
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
GR0079250
CA
01
PA14146
PA LICENSE
CA
01
ZZZ13239Z
GROUP PTAN
CA
Enumeration date
04/01/2008
Last updated
02/14/2012
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