Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086X0206X | Surgical Oncologist | G14575 | NY |
NPI | 1447516935 |
---|---|
Provider Name | Dr. Fank B Callipari X |
First Address | Poway, CA 92064-6709 |
Second Address | Poway, CA 92064-6709 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/04/2012 |
Last Update Date | 09/04/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
208600000X | TOXONOMY PROVIDER (01) |