Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0208X | Pediatric Infectious Diseases | G51307 | CA |
NPI | 1255490918 |
---|---|
Provider Name | Bradley K. Ackerson |
First Address | Harbor City, CA 90710-3518 |
Second Address | Harbor City, CA 90710-3518 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/12/2006 |
Last Update Date | 01/12/2021 |