Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | G81976 | CA |
NPI | 1003857715 |
---|---|
Provider Name | Giselle Maria Petzinger |
First Address | Los Angeles, CA 90031-0309 |
Second Address | Los Angeles, CA 90033-5310 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2006 |
Last Update Date | 09/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F29203 | (02) | CA |