Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 20A15035 | CA |
N | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 20A15035 | CA |
NPI | 1225410582 |
---|---|
Provider Name | Dr. David Alan Brethouwer |
First Address | San Diego, CA 92127-5705 |
Second Address | La Jolla, CA 92037-1035 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2015 |
Last Update Date | 10/06/2020 |