Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | A74573 | CA |
Y | 208600000X | Surgeon | A74573 | CA |
N | 2086S0102X | Surgical Critical Care | A74573 | CA |
N | 2086S0127X | Trauma Surgeon | A74573 | CA |
NPI | 1356372791 |
---|---|
Provider Name | Dr. Raul S Coimbra |
First Address | San Diego, CA 92193-2410 |
Second Address | San Diego, CA 92103-9001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2006 |
Last Update Date | 02/04/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A745730 | (05) | CA |
G84493 | (02) | CA |