Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0203X | Pediatric Critical Care Doctor | 005447 | AZ |
N | 2080P0203X | Pediatric Critical Care Doctor | 20A9613 | CA |
NPI | 1174847255 |
---|---|
Provider Name | Mr. David S Nathalang |
First Address | Tucson, AZ 85756-7124 |
Second Address | Tucson, AZ 85724 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/03/2010 |
Last Update Date | 29/05/2013 |