Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | G76281 | CA |
N | 208600000X | Surgeon | G76281 | CA |
Y | 2086S0102X | Surgical Critical Care | G76281 | CA |
NPI | 1295719276 |
---|---|
Provider Name | Dr. Scott Cunneen |
First Address | Los Angeles, CA 90051-0717 |
Second Address | Los Angeles, CA 90048-1865 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/12/2005 |
Last Update Date | 24/03/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G69458 | (02) | CA |