Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | A168466 | CA |
NPI | 1154705028 |
---|---|
Provider Name | Carl Truesdale |
First Address | Los Angeles, CA 90016-5209 |
Second Address | Beverly Hills, CA 90212-2445 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2015 |
Last Update Date | 30/11/2021 |