Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0007X | Plastic Surgeon (Head & Neck) | G30922 | CA |
NPI | 1205984176 |
---|---|
Provider Name | Alma N. Suehiro-Campa |
First Address | Pasadena, CA 91188-0001 |
Second Address | Woodland Hills, CA 91367-6701 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G309220 | (05) | CA |
A91317 | (02) |