Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | A78060 | CA |
N | 208000000X | Pediatrician | AA78060 | CA |
NPI | 1003877531 |
---|---|
Provider Name | Dr. Evangeline Gidaya Roxas-Butlig |
First Address | Torrance, CA 90501 |
Second Address | Torrance, CA 90501 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/04/2006 |
Last Update Date | 14/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A78060 | (05) | CA |