Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | C50519 | CA |
NPI | 1003033754 |
---|---|
Provider Name | Glory Cabanilla Tancinco |
First Address | Pasadena, CA 91116-6790 |
Second Address | Los Angeles, CA 90028-8253 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2007 |
Last Update Date | 17/10/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00C505190 | (05) | CA |
47864 | (02) | CA |