Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | A79142 | CA |
Y | 207PP0204X | Pediatric Emergency Physician | A79142 | CA |
NPI | 1437184421 |
---|---|
Provider Name | Paul T Ishimine |
First Address | Los Angeles, CA 90074-4826 |
Second Address | La Jolla, CA 92037 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2006 |
Last Update Date | 18/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A791420 | (05) | CA |
H61660 | (02) |