Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | 20A11392 | CA |
NPI | 1205838448 |
---|---|
Provider Name | Dr. Howard Jay Waldman |
First Address | San Diego, CA 92117-6906 |
Second Address | San Diego, CA 92117-6906 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2005 |
Last Update Date | 13/10/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C50505 | (02) |