Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0105X | Surgery of the Hand | A169842 | CA |
NPI | 1790072718 |
---|---|
Provider Name | Dr. Emily Nicole Othello Perez |
First Address | La Mirada, CA 90638-5824 |
Second Address | La Mirada, CA 90638-5824 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2011 |
Last Update Date | 20/08/2020 |