Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | G29196 | CA |
NPI | 1073683405 |
---|---|
Provider Name | Theodore R Corwin |
First Address | Westlake Village, CA 91361-2818 |
Second Address | Westlake Village, CA 91361-2818 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/11/2006 |
Last Update Date | 30/03/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A91177 | (02) | CA |