Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | A74560 | CA |
N | 111NI0900X | Internist | A74560 | CA |
Y | 207RA0401X | Internist - Addiction Medicine | 61-0572 | CA |
NPI | 1255446688 |
---|---|
Provider Name | Dr. Geoffrey A Booth |
First Address | Agoura Hills, CA 91301-6095 |
Second Address | Agoura Hills, CA 91301-6095 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2006 |
Last Update Date | 21/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H82933 | (02) | CA |