Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080N0001X | Neonatal-Perinatal Doctor | G62352 | CA |
NPI | 1144230707 |
---|---|
Provider Name | Bradley Jackson Holden |
First Address | Oakland, CA 94602 |
Second Address | Oakland, CA 94602 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2006 |
Last Update Date | 09/03/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G623520 | (05) | CA |
F15862 | (02) |