Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 4301084844 | MI |
Y | 208600000X | Surgeon | 4301084844 | MI |
N | 2086S0120X | Pediatric Surgery | A70300 | CA |
NPI | 1497971790 |
---|---|
Provider Name | Daniel Alberto Deugarte |
First Address | Los Angeles, CA 90045-5631 |
Second Address | Los Angeles, CA 90095-3075 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2007 |
Last Update Date | 08/03/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A703000 | (05) | CA |