Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | C53383 | CA |
NPI | 1003873720 |
---|---|
Provider Name | Dr. Ithaar Derweesh |
First Address | San Diego, CA 92193-2410 |
Second Address | San Diego, CA 92103-9000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/04/2006 |
Last Update Date | 13/08/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3332625 | (05) | TN |
H62034 | (02) |