Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0202X | Pediatric Cardiologist | A86946 | CA |
NPI | 1235225921 |
---|---|
Provider Name | Jondavid Menteer |
First Address | Los Angeles, CA 90028-7901 |
Second Address | Los Angeles, CA 90028-7315 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2006 |
Last Update Date | 09/08/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A869460 | (05) | CA |
00A869460 F98 | CAL OPTIMA (01) | CA |
I13700 | (02) | CA |