Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | MT193625 | PA |
Y | 2080P0208X | Pediatric Infectious Diseases | A149993 | CA |
NPI | 1083927552 |
---|---|
Provider Name | Annabelle De St. Maurice |
First Address | Los Angeles, CA 90045-5631 |
Second Address | Los Angeles, CA 90095-3075 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2010 |
Last Update Date | 17/03/2018 |