Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207U00000X | Nuclear Medicine Specialist | A97526 | CA |
NPI | 1023210473 |
---|---|
Provider Name | Desi Elpidio Barroga |
First Address | Ewa Beach, HI 96706-1814 |
Second Address | Glendale, CA 91204-2508 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2007 |
Last Update Date | 11/12/2008 |