Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | A172945 | CA |
Y | 2080P0214X | Pediatric Pulmonologist | A172945 | CA |
NPI | 1255750360 |
---|---|
Provider Name | Jeremy Saed Landeo Gutierrez |
First Address | San Diego, CA 92123-4223 |
Second Address | San Diego, CA 92123-4232 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/04/2014 |
Last Update Date | 11/06/2021 |