Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | G7431 | CA |
NPI | 1548373889 |
---|---|
Provider Name | Cadvan Owen Griffiths JR. |
First Address | Los Angeles, CA 90025-5781 |
Second Address | Los Angeles, CA 90025-5781 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D73229 | (02) | CA |