Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RP1001X | Pulmonary Disease | A46606 | CA |
NPI | 1033415773 |
---|---|
Provider Name | Elizabeth Lee Chuy |
First Address | San Jacinto, CA 92583-4206 |
Second Address | San Jacinto, CA 92583-4206 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/01/2011 |
Last Update Date | 27/01/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F19624 | (02) | CA |