Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | A41548 | CA |
NPI | 1063470219 |
---|---|
Provider Name | Dr. Ellis Norman Beesley JR. |
First Address | Los Angeles, CA 90017-3901 |
Second Address | Los Angeles, CA 90017-3901 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2006 |
Last Update Date | 21/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A29402 | (02) |