Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | A116772 | CA |
N | 208600000X | Surgeon | A116772 | CA |
Y | 2082S0105X | Plastic Hand Surgeon | A116772 | CA |
NPI | 1720304447 |
---|---|
Provider Name | Dr. Sanjeev Naresh Puri |
First Address | Pasadena, CA 91105-3010 |
Second Address | Pasadena, CA 91105-3132 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2010 |
Last Update Date | 25/06/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A116772 | MEDICAL LIC (01) | CA |