Taxonomy Codes
The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:
| No. |
Taxonomy Code |
Taxonomy Clasification |
Taxonomy Specialization |
License Number |
License State |
Primary |
| 1 | 207W00000X | Ophthalmology | | G84926 | CALIFORNIA | Yes |
Other Identifiers
The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.
| No. |
Other Provider Identifier |
Other Provider Identifier Type |
Other Provider Identifier State |
Other Provider Identifier Issuer |
| 1 | 20155344 93401 A001 | OTHER | CALIFORNIA | TRICARE GRP PIN - SLO |
| 2 | ZZZ09808Z | OTHER | CALIFORNIA | BLUE SHIELD SLO GRP PIN |
| 3 | ZZZ09809Z | OTHER | CALIFORNIA | BLUE SHIELD AG GRP PIN |
| 4 | G52015 | MEDICARE UPIN | CALIFORNIA | |
| 5 | DC7249 | OTHER | | RR MEDICARE GRP PIN |
| 6 | GR0099342 | MEDICAID | CALIFORNIA | |
| 7 | ZZZ09810Z | OTHER | CALIFORNIA | BLUE SHIELD SM GRP PIN |
| 8 | GR0099341 | MEDICAID | CALIFORNIA | |
| 9 | ZZZ65444Z | OTHER | CALIFORNIA | BLUE SHIELD TMPLTN GP PIN |
| 10 | WG84926J | MEDICARE PIN | | |
| 11 | 1117 | OTHER | CALIFORNIA | CMSP GRP PIN |
| 12 | 201555344 93420 A001 | OTHER | CALIFORNIA | TRICARE GRP PIN - AG |
| 13 | GR0099343 | MEDICAID | CALIFORNIA | |
| 14 | W18344 | MEDICARE PIN | | |
| 15 | 201555344 93454 A001 | OTHER | CALIFORNIA | TRICARE GROUP PIN - SM |
| 16 | G84926 | OTHER | CALIFORNIA | MEDICAL LICENSE NUMBER |
| 17 | P00213688 | OTHER | | INDIV RR MEDICARE PIN |
| 18 | 00G849260 | MEDICAID | CALIFORNIA | |
| 19 | GR0099340 | MEDICAID | CALIFORNIA | |
| 20 | WG84926I | MEDICARE PIN | | |