Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | A166689 | CA |
Y | 111NI0900X | Internist | A166689 | CA |
N | 207R00000X | Internist | MD459232 | PA |
N | 111NI0900X | Internist | MD459232 | PA |
NPI | 1003255654 |
---|---|
Provider Name | Mauricio Jalife Bucay |
First Address | Tiburon, CA 94920-1737 |
Second Address | Philadelphia, PA 19120-2421 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2013 |
Last Update Date | 21/05/2021 |