Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0202X | Pediatric Cardiologist | G63730 | CA |
N | 2080P0202X | Pediatric Cardiologist | G63760 | CA |
NPI | 1144323213 |
---|---|
Provider Name | Dr. Mark Steven Sklansky |
First Address | Los Angeles, CA 90095-3075 |
Second Address | Los Angeles, CA 90027-6062 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/09/2006 |
Last Update Date | 08/08/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G637600 | (05) | CA |
I68661 | (02) | CA |