Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0120X | Pediatric Surgery | A67995 | CA |
NPI | 1467560045 |
---|---|
Provider Name | Dr. Roman M Sydorak |
First Address | Los Angeles, CA 90027-6063 |
Second Address | Los Angeles, CA 90027-6063 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/08/2006 |
Last Update Date | 01/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A679950 | (05) | CA |