Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | A91510 | CA |
N | 208600000X | Surgeon | A91510 | CA |
Y | 2086S0122X | Plastic and Reconstructive Surgery | A91510 | CA |
NPI | 1144480492 |
---|---|
Provider Name | Dr. Alexander Quidayan Ereso |
First Address | Mountain View, CA 94040-4213 |
Second Address | Mountain View, CA 94040-4213 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2008 |
Last Update Date | 22/05/2014 |