Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RP1001X | Pulmonary Disease | G33671 | CA |
NPI | 1033105614 |
---|---|
Provider Name | Roger Amerian |
First Address | West Hills, CA 91307-1468 |
Second Address | West Hills, CA 91307-1468 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A45631 | (02) | |
GR0022620 | (05) | CA |