Individual
NGA T LE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1717 S MAIN ST, MILPITAS, CA 95035-6756
(408) 957-5700
(650) 322-2904
Mailing address
3345 COPPER LEAF DR, SAN JOSE, CA 95132-2480
(650) 324-7912
(650) 322-2904
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA16365
CA
Other
Enumeration date
03/08/2007
Last updated
07/08/2007
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