Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204F00000X | Transplant Surgeon | G22460 | CA |
NPI | 1639103906 |
---|---|
Provider Name | Dr. Ronald W Busuttil |
First Address | Los Angeles, CA 90045-5631 |
Second Address | Los Angeles, CA 90095-8344 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2006 |
Last Update Date | 30/12/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G224600 | (05) | CA |
A41582 | (02) | CA |