Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | A114410 | CA |
N | 207ND0900X | Dermatopathologist | A114410 | CA |
NPI | 1386879708 |
---|---|
Provider Name | Philip Oliver Scumpia |
First Address | Los Angeles, CA 90045-5631 |
Second Address | Los Angeles, CA 90095-8344 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/05/2009 |
Last Update Date | 25/11/2019 |