Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 95096646 | CA |
N | 207NS0135X | Procedural Dermatology | 95096646 | CA |
NPI | 1003269549 |
---|---|
Provider Name | Annette Mcauley |
First Address | Newport Beach, CA 92660-7720 |
Second Address | Newport Beach, CA 92660-7720 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2016 |
Last Update Date | 20/07/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A49832 | (02) | CA |