Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2082S0105X | Plastic Hand Surgeon | G68244 | CA |
NPI | 1396798195 |
---|---|
Provider Name | Andres Taleisnik |
First Address | Orange, CA 92868-4225 |
Second Address | Orange, CA 92868-4225 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F12026 | (02) |