Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VE0102X | Reproductive Endocrinologist | 20010 | AZ |
NPI | 1518959477 |
---|---|
Provider Name | Vladimir Troche |
First Address | Glendale, AZ 85308-3795 |
Second Address | Glendale, AZ 85308-3795 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2005 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
73350 | (02) | AZ |