Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | A24383 | CA |
Y | 207VG0400X | Gynecologist | A24383 | CA |
NPI | 1083622294 |
---|---|
Provider Name | Subir Roy |
First Address | Los Angeles, CA 90031 |
Second Address | Los Angeles, CA 90033 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2006 |
Last Update Date | 06/12/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A243830 | (05) | CA |
00A243830 | BLUE SHIELD (01) | CA |
1992740450 | GROUP NPI (01) | |
A24383 | STATE LICENSE (01) | CA |
F26702 | (02) |