Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RP1001X | Pulmonary Disease | A31438 | CA |
NPI | 1053505982 |
---|---|
Provider Name | Dr. Frankie D Utzurrum |
First Address | Upland, CA 91786-4579 |
Second Address | Upland, CA 91786-4579 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/09/2007 |
Last Update Date | 25/03/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A314380 | (05) | CA |
A26481 | (02) | CA |