Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 20A16077 | CA |
NPI | 1265810337 |
---|---|
Provider Name | Alice I-Chi Chen |
First Address | La Jolla, CA 92093-0980 |
Second Address | San Diego, CA 92103-9000 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2015 |
Last Update Date | 07/01/2019 |