Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | A33955 | CA |
NPI | 1043358104 |
---|---|
Provider Name | Dr. Juana Constantina Phillipp |
First Address | Glendora, CA 91740-6249 |
Second Address | Glendora, CA 91740-6249 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/02/2007 |
Last Update Date | 10/06/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A84544 | (02) | CA |
OOA339550 | (05) | CA |