Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | A 109157 | CA |
N | 208000000X | Pediatrician | ME98245 | FL |
NPI | 1003024977 |
---|---|
Provider Name | Pawena Virulhsri |
First Address | Pasadena, CA 91188-0001 |
Second Address | Palmdale, CA 93552-4480 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2007 |
Last Update Date | 29/11/2021 |