Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | G35390 | CA |
Y | 207R00000X | Internist | G35390 | CA |
Y | 111NI0900X | Internist | G35390 | CA |
N | 207RG0300X | Geriatric Medicine | G35390 | CA |
NPI | 1164441085 |
---|---|
Provider Name | Rose Carmen Maly |
First Address | Los Angeles, CA 90045-5632 |
Second Address | Los Angeles, CA 90095 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2006 |
Last Update Date | 13/07/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G353900 | (05) | CA |
A91678 | (02) | CA |