Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0200X | Radiology | DC20598 | CA |
Y | 213ER0200X | Radiology | DC20598 | CA |
NPI | 1427247949 |
---|---|
Provider Name | Dr. David Floyd Gendreau |
First Address | La Mirada, CA 90638-5824 |
Second Address | Perris, CA 92571-2657 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/10/2007 |
Last Update Date | 03/07/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
DC0205980 | MEDI-CAL (01) | CA |