Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207U00000X | Nuclear Medicine Specialist | RHN00003576 | CA |
NPI | 1255950655 |
---|---|
Provider Name | Walter Mcmillan |
First Address | Los Angeles, CA 90008-3624 |
Second Address | Los Angeles, CA 90008-3624 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/04/2020 |
Last Update Date | 15/04/2020 |