Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | A67643 | CA |
N | 207PE0004X | Emergency Medical Services | A67643 | CA |
NPI | 1073509238 |
---|---|
Provider Name | Dr. Anthony Loffredo |
First Address | Los Angeles, CA 90051-5558 |
Second Address | Los Angeles, CA 90048-1865 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/09/2005 |
Last Update Date | 06/08/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H57738 | (02) | CA |