Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0208X | Pediatric Infectious Diseases | G41428 | CA |
NPI | 1073611778 |
---|---|
Provider Name | Andrea A Kovacs |
First Address | Alhambra, CA 91803 |
Second Address | Los Angeles, CA 90033 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 08/07/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G414280 | (05) | CA |
A89725 | (02) | CA |