Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0100X | Occupational Health | 26681 | CA |
NPI | 1518150978 |
---|---|
Provider Name | Gustavo Miguel Bianchi |
First Address | Los Angeles, CA 90015-2178 |
Second Address | Los Angeles, CA 90015-2178 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2007 |
Last Update Date | 20/08/2007 |