Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207NS0135X | Procedural Dermatology | G66948 | CA |
NPI | 1295735322 |
---|---|
Provider Name | Annette J Gottlieb |
First Address | Beverly Hills, CA 90211-2007 |
Second Address | Beverly Hills, CA 90211-2007 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/07/2005 |
Last Update Date | 13/12/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F72020 | (02) | CA |