Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 61700 | CT |
NPI | 1003295023 |
---|---|
Provider Name | Dr. Danice Kuruvilla |
First Address | New Haven, CT 06504-8901 |
Second Address | New Haven, CT 06504 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2015 |
Last Update Date | 09/08/2018 |