Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | A29865 | CA |
NPI | 1174528657 |
---|---|
Provider Name | Raffaele A. Davidovich |
First Address | Anaheim, CA 92801 |
Second Address | Anaheim, CA 92801-2607 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2005 |
Last Update Date | 09/11/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A298650 | MEDI CAL # (01) | CA |
B50116 | (02) | CA |