Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | A85478 | CA |
Y | 207VX0000X | Obstetrician | A85478 | CA |
NPI | 1154329373 |
---|---|
Provider Name | Dr. Paulus L. Santoso |
First Address | Riverside, CA 92506-3809 |
Second Address | Riverside, CA 92506-3809 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2005 |
Last Update Date | 04/03/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A854780 | (05) | CA |
H73276 | (02) | CA |