Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | G65991 | CA |
N | 207PE0004X | Emergency Medical Services | G65991 | CA |
NPI | 1215044755 |
---|---|
Provider Name | Dr. Leonard Popky |
First Address | Monterey, CA 93940-5809 |
Second Address | Monterey, CA 93940-5902 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2006 |
Last Update Date | 23/10/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G659910 | BLUE SHIELD (01) | CA |
930099460 | RAILROAD (01) | CA |
F11848 | (02) | CA |