Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RI0200X | Infectious Disease | C142571 | CA |
NPI | 1053763490 |
---|---|
Provider Name | Blayne Cutler |
First Address | City Of Industry, CA 91746-3502 |
Second Address | City Of Industry, CA 91746-3502 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2016 |
Last Update Date | 11/07/2016 |