Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | G84331 | CA |
NPI | 1003942657 |
---|---|
Provider Name | Mary Gatter |
First Address | Los Angeles, CA 90007-3320 |
Second Address | Los Angeles, CA 90007-3320 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/02/2007 |
Last Update Date | 04/01/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G84331 | LICENSE (01) | CA |