Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0402X | Child Neurologist | A120194 | CA |
NPI | 1174870067 |
---|---|
Provider Name | Olivia Kim Mcmanus |
First Address | San Diego, CA 92123-4223 |
Second Address | San Diego, CA 92123-2746 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2012 |
Last Update Date | 17/03/2018 |