Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | G66613 | CA |
NPI | 1013929231 |
---|---|
Provider Name | Darci J. Tom |
First Address | San Diego, CA 92123-1810 |
Second Address | San Diego, CA 92123-1810 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/08/2006 |
Last Update Date | 25/04/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G666130 | (05) | CA |
00G666130 | BLUE SHIELD OF CA (01) | CA |
F40031 | (02) | CA |