Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2084N0402X | Child Neurologist | 01083335A | IN |
Y | 2084N0402X | Child Neurologist | A131704 | CA |
NPI | 1154688604 |
---|---|
Provider Name | Jyes Annemarie Querubin |
First Address | Pasadena, CA 91105-3206 |
Second Address | Pasadena, CA 91105-3206 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2012 |
Last Update Date | 17/11/2021 |