Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 48759 | CA |
NPI | 1003937871 |
---|---|
Provider Name | Dr. Brian Oleksy |
First Address | San Diego, CA 92103-4980 |
Second Address | San Diego, CA 92103-4980 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/04/2007 |
Last Update Date | 08/07/2007 |