Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | G39919 | CA |
NPI | 1003855826 |
---|---|
Provider Name | James V Pagano |
First Address | Woodland Hills, CA 91365-4419 |
Second Address | San Dimas, CA 91773-3245 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2006 |
Last Update Date | 20/04/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G399190 | (05) | CA |
00G399190 | BLUE SHIELD (01) | CA |
930099138 | RAILROAD MEDICARE (01) | CA |
A48016 | (02) | CA |