Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | A70021 | CA |
Y | 2086S0120X | Pediatric Surgery | A70021 | CA |
NPI | 1083820716 |
---|---|
Provider Name | Dean Michael Anselmo |
First Address | Los Angeles, CA 90028-7909 |
Second Address | Los Angeles, CA 90027-6062 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2007 |
Last Update Date | 26/01/2018 |