Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207U00000X | Nuclear Medicine Specialist | G74168 | CA |
NPI | 1083703805 |
---|---|
Provider Name | Dr. Ernest V. Belezzuoli |
First Address | San Diego, CA 92161-0002 |
Second Address | San Diego, CA 92161-0002 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2006 |
Last Update Date | 31/01/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G741680 | (05) | CA |
F68551 | (02) | CA |