Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | A132755 | CA |
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 2009-01996 | NC |
NPI | 1063672145 |
---|---|
Provider Name | Millie Jay Surati-Tantod |
First Address | Whittier, CA 90606-2500 |
Second Address | Huntington Beach, CA 92649-6030 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2008 |
Last Update Date | 14/03/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5916400 | (05) | NC |