Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0200X | Critical Care Medicine | A79991 | CA |
Y | 207RP1001X | Pulmonary Disease | A79991 | CA |
N | 207RS0012X | Sleep Medicine | A79991 | CA |
NPI | 1083833131 |
---|---|
Provider Name | Roman Mark Culjat |
First Address | Torrance, CA 90505-4753 |
Second Address | Torrance, CA 90505-4753 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2007 |
Last Update Date | 10/05/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1083833131 | (05) | CA |
1083833131 | CCS PANELED (01) | CA |