Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | A88203 | CA |
Y | 2080N0001X | Neonatal-Perinatal Doctor | A88203 | CA |
NPI | 1093809667 |
---|---|
Provider Name | Bergen Elizabeth Folsom |
First Address | San Diego, CA 92123 |
Second Address | San Diego, CA 92123 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2006 |
Last Update Date | 24/07/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A901670 | (05) | CA |