Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | C51134 | CA |
NPI | 1114027505 |
---|---|
Provider Name | Berkeley Brandt III |
First Address | Bakersfield, CA 93301-2284 |
Second Address | Ventura, CA 93003-2816 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/09/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B82901 | (02) |