Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | A38757 | CA |
Y | 208D00000X | General Practice Physician | A38757 | CA |
NPI | 1013035609 |
---|---|
Provider Name | Dr. Santiago Dayoan Corpuz |
First Address | Los Angeles, CA 90004-3101 |
Second Address | Los Angeles, CA 90004-3101 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2007 |
Last Update Date | 15/12/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A85170 | (02) | CA |