Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207L00000X | Anesthesiologist | A147411 | CA |
N | 208000000X | Pediatrician | A147411 | CA |
Y | 2080P0203X | Pediatric Critical Care Doctor | A147411 | CA |
NPI | 1114160991 |
---|---|
Provider Name | Branden Michael Engorn |
First Address | San Diego, CA 92123-1810 |
Second Address | San Diego, CA 92123-1810 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/04/2009 |
Last Update Date | 28/06/2019 |