Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207U00000X | Nuclear Medicine Specialist | C50633 | CA |
NPI | 1588735534 |
---|---|
Provider Name | Raul Jay Santos Idea |
First Address | Woodland Hills, CA 91367-6701 |
Second Address | Woodland Hills, CA 91367-6701 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/11/2006 |
Last Update Date | 18/11/2021 |