Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | G143603 | CA |
NPI | 1043281850 |
---|---|
Provider Name | Dr. David Mark Edward Llewellyn |
First Address | Oceanside, CA 92055 |
Second Address | Oceanside, CA 92055 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2006 |
Last Update Date | 20/04/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
790956 | (05) | AZ |