Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | OPT12109 | CA |
NPI | 1003806233 |
---|---|
Provider Name | Brenda J Swiderski |
First Address | La Mesa, CA 91942-2104 |
Second Address | San Diego, CA 92115-1754 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/10/2005 |
Last Update Date | 23/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
GR0052930 | (05) | CA |