Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0200X | Radiology | 16473 | CA |
Y | 213ER0200X | Radiology | 16473 | CA |
NPI | 1457014920 |
---|---|
Provider Name | Deborah Pate |
First Address | San Diego, CA 92103-4404 |
Second Address | San Diego, CA 92103-4404 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/10/2021 |
Last Update Date | 20/10/2021 |