Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0000X | Obstetrician | 00C426610 | CA |
NPI | 1093803280 |
---|---|
Provider Name | Pablito A Tancinco |
First Address | Los Angeles, CA 90026-5421 |
Second Address | Los Angeles, CA 90026-5421 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2006 |
Last Update Date | 16/04/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00C426610 | (05) | CA |
B71600 | (02) | CA |