Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | G64029 | CA |
Y | 2080P0210X | Pediatric Nephrologist | G64029 | CA |
NPI | 1023039831 |
---|---|
Provider Name | Peter D Yorgin |
First Address | San Diego, CA 92123-4802 |
Second Address | San Diego, CA 92123-2746 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2006 |
Last Update Date | 14/10/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G640290 | (05) | CA |