Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | A78977 | CA |
Y | 208600000X | Surgeon | A78977 | CA |
N | 2086X0206X | Surgical Oncologist | A78977 | CA |
NPI | 1134225683 |
---|---|
Provider Name | Mr. Vijay Trisal |
First Address | Los Angeles, CA 90051-0185 |
Second Address | Duarte, CA 91010 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2006 |
Last Update Date | 10/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A789770 | (05) | CA |
H75911 | (02) |