Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0202X | Pediatric Cardiologist | C50168 | CA |
NPI | 1265414833 |
---|---|
Provider Name | Elizabeth R Deoliveira |
First Address | Pasadena, CA 91105-3132 |
Second Address | Pasadena, CA 91105-3132 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/11/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F44293 | (02) | |
OOC501680 | (05) | CA |