Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0003X | Hematology & Oncology | G39425 | CA |
NPI | 1033184890 |
---|---|
Provider Name | Marilou Terpenning |
First Address | Pacific Palisades, CA 90272-2844 |
Second Address | Pacific Palisades, CA 90272-2844 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2006 |
Last Update Date | 22/12/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
AT8787751 | DEA NUMBER (01) | CA |
E83318 | (02) | CA |
G39425 | CALIFORNIA LICENSE (01) | CA |
G394250 | (05) | CA |
GR0085740 | (05) | CA |