Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 26495 | CA |
Y | 213EG0000X | General Practice | 26495 | CA |
NPI | 1003036476 |
---|---|
Provider Name | Dr. Dane Buss Nielsen |
First Address | Ventura, CA 93003-6050 |
Second Address | Ventura, CA 93003-6050 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2007 |
Last Update Date | 08/07/2007 |