Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | C032628 | CA |
NPI | 1013959253 |
---|---|
Provider Name | Mr. Mark Steven Sugar |
First Address | Mission Viejo, CA 92691 |
Second Address | Mission Viejo, CA 92691 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2006 |
Last Update Date | 11/08/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A87598 | (02) | CA |