Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RI0200X | Infectious Disease | F13854 | CA |
NPI | 1013972876 |
---|---|
Provider Name | Dr. Jean-Pierre E Antaki |
First Address | Glendale, CA 91205-4431 |
Second Address | Glendale, CA 91205-4431 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A44202 | (02) | CA |