Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | G78038 | CA |
Y | 208D00000X | General Practice Physician | G78038 | CA |
NPI | 1033153754 |
---|---|
Provider Name | Dee M L'archeveque |
First Address | Hemet, CA 92546-0788 |
Second Address | Temecula, CA 92591-5120 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2006 |
Last Update Date | 31/08/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G49385 | (02) | CA |