Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 170100000X | Medical Geneticist | ABMG-96135 | CA |
Y | 170100000X | Medical Geneticist | DRN 9 | CA |
NPI | 1023214319 |
---|---|
Provider Name | Dr. Matthew Jerome Mcginniss |
First Address | San Diego, CA 92129-1107 |
Second Address | San Diego, CA 92121-5201 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
ABMG-96135 | MEDICAL GENETICS PHD (01) | |
DRN9 | CL GENETIC MOLECULAR BIOL (01) | CA |