Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | A101859 | CA |
NPI | 1457391468 |
---|---|
Provider Name | Mauricio Silva |
First Address | Los Angeles, CA 90007-2664 |
Second Address | Los Angeles, CA 90007 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2006 |
Last Update Date | 20/08/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1457391468 | (05) | CA |