Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | A69804 | CA |
NPI | 1013076611 |
---|---|
Provider Name | Brennen J. Beatty |
First Address | Los Angeles, CA 90034-1702 |
Second Address | Los Angeles, CA 90034-1702 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/12/2006 |
Last Update Date | 23/09/2008 |