Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207SG0201X | Clinical Genetics (M.D.) | G23474 | CA |
NPI | 1649341686 |
---|---|
Provider Name | Diane L. Broome |
First Address | Anaheim, CA 92807-3028 |
Second Address | Anaheim, CA 92807-3028 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/11/2006 |
Last Update Date | 29/11/2021 |