Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | G53870 | CA |
NPI | 1003849761 |
---|---|
Provider Name | Thomas J. Pietuch |
First Address | San Diego, CA 92123-1810 |
Second Address | San Diego, CA 92123-1810 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2006 |
Last Update Date | 06/12/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G538700 | (05) | CA |
00G538700 | BLUE SHIELD OF CA (01) | CA |
F26923 | (02) | CA |