Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | A44924 | CA |
NPI | 1598783789 |
---|---|
Provider Name | Peter J Parker |
First Address | Glendale, CA 91221-2108 |
Second Address | Glendale, CA 91202-2606 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2006 |
Last Update Date | 28/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A449240 | (05) | CA |
B78185 | (02) | CA |