Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | A71675 | CA |
N | 207PP0204X | Pediatric Emergency Physician | A71675 | CA |
NPI | 1194871749 |
---|---|
Provider Name | Keri Lyn Carstairs |
First Address | San Diego, CA 92123-4800 |
Second Address | San Diego, CA 92123-4223 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A716750 | (05) | CA |
I45291 | (02) | CA |