Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | A88009 | CA |
NPI | 1043252786 |
---|---|
Provider Name | Dr. Michelle Terez Pelle |
First Address | San Diego, CA 92103-2184 |
Second Address | San Diego, CA 92103-2184 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2006 |
Last Update Date | 03/10/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A880090 | (05) | CA |
H38561 | (02) | CA |