Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | A111253 | CA |
N | 208600000X | Surgeon | A111253 | CA |
Y | 2086X0206X | Surgical Oncologist | A111253 | CA |
NPI | 1073760815 |
---|---|
Provider Name | Dr. Amy Caton Polverini |
First Address | Los Angeles, CA 90051-0185 |
Second Address | South Pasadena, CA 91030-1814 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/08/2008 |
Last Update Date | 28/10/2020 |