Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | A95461 | CA |
NPI | 1013132448 |
---|---|
Provider Name | Carolyn Sims |
First Address | Woodland Hills, CA 91367-6701 |
Second Address | Burbank, CA 91505-4800 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2007 |
Last Update Date | 07/12/2011 |