Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0200X | Critical Care Medicine | A69561 | CA |
Y | 207RP1001X | Pulmonary Disease | A69561 | CA |
NPI | 1053441329 |
---|---|
Provider Name | Pratan Vathesatogkit |
First Address | Oceanside, CA 92056-4510 |
Second Address | Oceanside, CA 92056-4510 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/03/2007 |
Last Update Date | 28/09/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H89757 | (02) |