Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | A1314172 | CA |
Y | 207QG0300X | Family Doctor - Geriatric Medicine | A114172 | CA |
NPI | 1023300019 |
---|---|
Provider Name | Carolyn L. Kaloostian |
First Address | Los Angeles, CA 90031-0309 |
Second Address | Los Angeles, CA 90033-5310 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/05/2011 |
Last Update Date | 28/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A114172 | CA MEDICAL LICENSE (01) | CA |