Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | G66851 | CA |
NPI | 1063523330 |
---|---|
Provider Name | Dr. Lee P Ralph |
First Address | San Diego, CA 92120-5238 |
Second Address | San Diego, CA 92120-5238 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 24/08/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E86777 | (02) | CA |