Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | P20264 | MD |
Y | 2080N0001X | Neonatal-Perinatal Doctor | A110761 | CA |
N | 2080P0202X | Pediatric Cardiologist | A110761 | CA |
N | 2080P0204X | Pediatric Emergency Doctor | D67515 | MD |
NPI | 1164572632 |
---|---|
Provider Name | Dr. Nathaly Maria Coromoto Sweeney |
First Address | La Jolla, CA 92037-1300 |
Second Address | La Jolla, CA 92037-1300 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/01/2007 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
018764000 | (05) | MD |