Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PP0204X | Pediatric Emergency Physician | A103920 | CA |
NPI | 1417103177 |
---|---|
Provider Name | Marie Waterhouse |
First Address | Los Angeles, CA 90028-7901 |
Second Address | Los Angeles, CA 90027-6062 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/08/2008 |
Last Update Date | 13/08/2008 |