Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0000X | Obstetrician | G675681 | CA |
NPI | 1083770622 |
---|---|
Provider Name | Mr. Alexander B Deyan |
First Address | Newport Beach, CA 92660 |
Second Address | Newport Beach, CA 92660 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/12/2006 |
Last Update Date | 02/11/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G675681 | (05) | CA |
F11361 | (02) |