Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | A30768 | CA |
NPI | 1144463415 |
---|---|
Provider Name | Mrs. Samara Palacio Cardenas |
First Address | Anaheim, CA 92801-2805 |
Second Address | Anaheim, CA 92801-2805 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/04/2009 |
Last Update Date | 15/04/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A307680 | (05) | CA |