Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0402X | Child Neurologist | 036.138406 | IL |
N | 2084N0402X | Child Neurologist | A119728 | CA |
NPI | 1003010059 |
---|---|
Provider Name | Andrea Catalina Pardo |
First Address | Loma Linda, CA 92350-1700 |
Second Address | Chicago, IL 60611-2991 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2007 |
Last Update Date | 14/02/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A119728 | CALIFORNIA LICENSE (01) | CA |
FP3098109 | DEA (01) |