Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | A86651 | CA |
NPI | 1013976612 |
---|---|
Provider Name | Suja Devi Dubois |
First Address | San Diego, CA 92103-2120 |
Second Address | San Diego, CA 92103-2120 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2006 |
Last Update Date | 07/07/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I14215 | (02) | |
ZZZ81882Z | (05) | CA |