Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | G62787 | CA |
NPI | 1144375809 |
---|---|
Provider Name | Monica Sifuentes |
First Address | Torrance, CA 90502-2004 |
Second Address | Torrance, CA 90502-2004 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F11969 | (02) | CA |