Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080N0001X | Neonatal-Perinatal Doctor | A87019 | CA |
NPI | 1114019486 |
---|---|
Provider Name | Mr. Gary Go Laborada |
First Address | Redlands, CA 92375-1388 |
Second Address | Riverside, CA 92503-3919 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/09/2006 |
Last Update Date | 29/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A870190 | (05) | CA |