Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0203X | Pediatric Critical Care Doctor | A42572 | CA |
NPI | 1205866258 |
---|---|
Provider Name | Mario Eduardo Eyzaguirre |
First Address | San Diego, CA 92122-4132 |
Second Address | San Diego, CA 92103-2105 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E92777 | (02) | CA |