Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207U00000X | Nuclear Medicine Specialist | G37042 | CA |
NPI | 1679513857 |
---|---|
Provider Name | Mark R Rockoff |
First Address | Irvine, CA 92623-6699 |
Second Address | Tarzana, CA 91356 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2006 |
Last Update Date | 27/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G370420 | (05) | CA |
00G370420 | BLUE SHIELD (01) | CA |
A46926 | (02) |