Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | A63218 | CA |
N | 207RI0200X | Infectious Disease | A63218 | CA |
NPI | 1033149711 |
---|---|
Provider Name | Joseph T Defoto |
First Address | Los Angeles, CA 90069-3701 |
Second Address | Los Angeles, CA 90069-3701 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2006 |
Last Update Date | 16/09/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A632180 | (05) | CA |
F60116 | (02) | CA |