Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0201X | Pediatric Allergist | C25375 | CA |
NPI | 1922117993 |
---|---|
Provider Name | Dr. Ewald Richard Stiehm |
First Address | Los Angeles, CA 90095-3075 |
Second Address | Los Angeles, CA 90095-3075 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 05/03/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00C253750 | (05) | CA |
A87003 | (02) | CA |
GR0053510 | (05) | CA |