Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | G86986 | CA |
NPI | 1023055928 |
---|---|
Provider Name | Kay E Elledge |
First Address | Torrance, CA 90505-4753 |
Second Address | Torrance, CA 90505-4753 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2006 |
Last Update Date | 11/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1023055928 | (05) | WI |
G41855 | (02) |