Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | G 83599 | CA |
NPI | 1043235120 |
---|---|
Provider Name | Dr. Garrett David Herzon |
First Address | Los Angeles, CA 90048-5901 |
Second Address | Los Angeles, CA 90048-5901 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2006 |
Last Update Date | 09/12/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
AH1999854 | DEA NUMBER (01) | |
C43189 | (02) | CA |