Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204F00000X | Transplant Surgeon | 77814 | GA |
Y | 208200000X | Surgeon | A124914 | CA |
Y | 208600000X | Surgeon | A124914 | CA |
NPI | 1376839449 |
---|---|
Provider Name | Jakub Woloszyn |
First Address | Loma Linda, CA 92354-3896 |
Second Address | Loma Linda, CA 92350-1700 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2011 |
Last Update Date | 24/07/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
RES000 | (02) | CA |