Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | A68560 | CA |
NPI | 1003800376 |
---|---|
Provider Name | Dr. J David D'amelio |
First Address | Sacramento, CA 95866-0910 |
Second Address | Sacramento, CA 95821-3600 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/09/2005 |
Last Update Date | 30/06/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
GR0028370 | (05) | CA |
H36039 | (02) | CA |