Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | A70323 | CA |
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | A70323 | CA |
NPI | 1780639914 |
---|---|
Provider Name | Dr. Brian D Madden |
First Address | Santa Monica, CA 90403-5627 |
Second Address | Santa Monica, CA 90403-5627 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2006 |
Last Update Date | 16/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
GR0091750 | (05) | CA |
H37887 | (02) | CA |