Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | G64236 | CA |
Y | 208600000X | Surgeon | G64236 | CA |
NPI | 1013924596 |
---|---|
Provider Name | Dr. Charles John Sarosy |
First Address | La Mesa, CA 91942 |
Second Address | La Mesa, CA 91942 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2006 |
Last Update Date | 21/11/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G642360 | (05) | CA |
F95031 | (02) | CA |