Taxonomy Codes
The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:
| No. |
Taxonomy Code |
Taxonomy Clasification |
Taxonomy Specialization |
License Number |
License State |
Primary |
| 1 | 207Q00000X | Family Medicine | | 200518 | CALIFORNIA | Yes |
Other Identifiers
The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.
| No. |
Other Provider Identifier |
Other Provider Identifier Type |
Other Provider Identifier State |
Other Provider Identifier Issuer |
| 1 | 9077680 | OTHER | | CIGNA HEALTH PLAN |
| 2 | 42367 | OTHER | | FALLON COMMUNITY HEALTH P |
| 3 | 042472266 | OTHER | | THREE RIVERS |
| 4 | 042472266 | OTHER | | PRIVATE HEALTHCARE SYSTEM |
| 5 | 3183475 | MEDICAID | MASSACHUSETTS | |
| 6 | J19558 | OTHER | | BLUE SHIELD INDEMNITY |
| 7 | J19558 | OTHER | | BLUE SHIELD HMO BLUE |
| 8 | 31001 | OTHER | | HEALTHY START |
| 9 | 2031301 | OTHER | | FIRST HEALTH |
| 10 | 31001 | OTHER | | CHILDRENS MEDICAL SECURIT |
| 11 | 3183475 | OTHER | | MEDICAID WELFARE |
| 12 | 5478684 | OTHER | | AETNA US HEALTHCARE |
| 13 | J19558 | OTHER | | BLUE CARE ELECT |
| 14 | 042472266 | OTHER | | ONE HEALTH PLAN |
| 15 | 155190 | OTHER | | TUFTS HEALTH PLAN |
| 16 | 71937 | OTHER | | HARVARD PILGRIM HEALTHCAR |
| 17 | 786721 | OTHER | | MVP HEALTH CARE |
