Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0204X | Pediatric Emergency Doctor | G73346 | CA |
NPI | 1154416022 |
---|---|
Provider Name | Calvin Glen Lowe |
First Address | Los Angeles, CA 90028-7901 |
Second Address | Los Angeles, CA 90027-6062 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G733460 | (05) | CA |
00G733460 851 | CAL OPTIMA (01) | CA |
F62394 | (02) | CA |