Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0214X | Pediatric Pulmonologist | A97024 | CA |
NPI | 1649382169 |
---|---|
Provider Name | Charalambos Opsimos |
First Address | Los Angeles, CA 90074-4701 |
Second Address | Loma Linda, CA 92354-3450 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A970240 | (05) | CA |
I61034 | (02) |