Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0203X | Pediatric Critical Care Doctor | A84467 | CA |
NPI | 1124054689 |
---|---|
Provider Name | Diego Mechoso |
First Address | Pasadena, CA 91116-6400 |
Second Address | Van Nuys, CA 91405-4542 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2006 |
Last Update Date | 01/04/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A844670 | (05) | CA |