Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | G154556 | CA |
Y | 207YP0228X | Pediatric Otolaryngology | 2012-00236 | NC |
N | 207YP0228X | Pediatric Otolaryngology | G154556 | CA |
N | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 2012-00236 | NC |
N | 207YX0905X | Otolaryngology/Facial Plastic Surgery | G154556 | CA |
NPI | 1861612772 |
---|---|
Provider Name | Rose J Eapen |
First Address | Manhattan Beach, CA 90266-2725 |
Second Address | Manhattan Beach, CA 90266-2727 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2007 |
Last Update Date | 09/07/2020 |