Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | A76981 | CA |
Y | 208600000X | Surgeon | A76981 | CA |
N | 2086S0122X | Plastic and Reconstructive Surgery | A76981 | CA |
NPI | 1134139132 |
---|---|
Provider Name | Dr. Walter Cansino Chua |
First Address | Long Beach, CA 90822-5201 |
Second Address | Long Beach, CA 90822-5201 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2006 |
Last Update Date | 11/07/2007 |