Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | D87058 | MD |
NPI | 1023357670 |
---|---|
Provider Name | Emma Coleen Mcdonnell |
First Address | Chula Vista, CA 91911-1352 |
Second Address | Chula Vista, CA 91911-1352 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/02/2013 |
Last Update Date | 07/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D87058 | LICENSE (01) | MD |