Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207SG0201X | Clinical Genetics (M.D.) | G63286 | CA |
NPI | 1821169715 |
---|---|
Provider Name | George E. Tiller |
First Address | Los Angeles, CA 90027-6063 |
Second Address | Los Angeles, CA 90027-6063 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/11/2006 |
Last Update Date | 29/11/2021 |