Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 20A8013 | CA |
N | 111NI0900X | Internist | 20A8013 | CA |
N | 207R00000X | Internist | 52487 | CT |
N | 111NI0900X | Internist | 52487 | CT |
N | 208000000X | Pediatrician | 20A8013 | CA |
Y | 2080P0203X | Pediatric Critical Care Doctor | 20A8013 | CA |
N | 2080P0203X | Pediatric Critical Care Doctor | 52487 | CT |
NPI | 1053422147 |
---|---|
Provider Name | Dr. Kevin Gottlieb Couloures |
First Address | Palo Alto, CA 94304-1511 |
Second Address | Palo Alto, CA 94304-1511 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 01/10/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0147168 | (05) | NJ |
102040456 | (05) | PA |
413716700 | (05) | MD |
I34682 | (02) |