Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | C50172 | CA |
NPI | 1104891951 |
---|---|
Provider Name | Sergio Da Silva Caminha |
First Address | Visalia, CA 93291-6238 |
Second Address | Visalia, CA 93291-6238 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2006 |
Last Update Date | 04/09/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1794429 | ECFMG (01) | |
C50172 | CA LINCENSE (01) | CA |
F42567 | (02) |