Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | G62759 | CA |
N | 2081P2900X | Pain Medicine | G62759 | CA |
NPI | 1023028024 |
---|---|
Provider Name | Dr. Johnathan S. Halperin |
First Address | La Mesa, CA 91942-3009 |
Second Address | La Mesa, CA 91942-3009 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2006 |
Last Update Date | 19/06/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G627590 | (05) | CA |
F11515 | (02) |