Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207SG0201X | Clinical Genetics (M.D.) | G88598 | CA |
NPI | 1487744330 |
---|---|
Provider Name | Albert Russell La Spada |
First Address | San Diego, CA 92123-4802 |
Second Address | San Diego, CA 92123-2736 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2006 |
Last Update Date | 14/10/2011 |