Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | G70873 | CA |
Y | 208600000X | Surgeon | G70873 | CA |
NPI | 1013966571 |
---|---|
Provider Name | Dr. David J Lourie |
First Address | Pasadena, CA 91105-3042 |
Second Address | Pasadena, CA 91105-3042 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2006 |
Last Update Date | 22/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F55836 | (02) | CA |