Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204F00000X | Transplant Surgeon | A79395 | CA |
N | 208200000X | Surgeon | A79395 | CA |
N | 208600000X | Surgeon | A79395 | CA |
NPI | 1053425330 |
---|---|
Provider Name | Angeles Baquerizo |
First Address | La Jolla, CA 92037 |
Second Address | La Jolla, CA 92037-1027 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2006 |
Last Update Date | 22/04/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H20346 | (02) | CA |