Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0001X | Advanced Heart Failure and Transplant Cardiologist | 95012551 | CA |
NPI | 1073161329 |
---|---|
Provider Name | Andrea Boettcher |
First Address | San Diego, CA 92123-2773 |
Second Address | San Diego, CA 92123-2701 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2019 |
Last Update Date | 29/08/2019 |