Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | A75058 | CA |
NPI | 1023029162 |
---|---|
Provider Name | Maie Abdul-Rahman St John |
First Address | Los Angeles, CA 90045-5631 |
Second Address | Los Angeles, CA 90095 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2006 |
Last Update Date | 09/04/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A750580 | (05) | CA |
I45875 | (02) | CA |